Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease
- Matti Waterman1,2,
- Wei Xu3,4,
- Amreen Dinani1,2,
- A Hillary Steinhart1,2,3,4,
- Kenneth Croitoru1,2,4,
- Geoffrey C Nguyen1,2,4,
- Robin S McLeod2,4,5,
- Gordon R Greenberg1,2,4,
- Zane Cohen2,4,5,
- Mark S Silverberg1,2,4
- 1Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada
- 2Zane Cohen Centre for Digestive Diseases, Toronto, Ontario, Canada
- 3Dalla Lana School of Public Health, Toronto, Ontario, Canada
- 4University of Toronto, Toronto, Ontario, Canada
- 5Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Correspondence to Dr Mark S Silverberg, Division of Gastroenterology, Mount Sinai Hospital, 600 University Ave., Room 441, Toronto, ON, Canada M5G 1X5;
Contributors MW, ZC, MSS: study design. MW, ZC, MSS: conception and preparation of manuscript. MW, AD, GRG: data acquisition. MW, WX, GRG: data analysis. AHS, KC, GCN, RSM, GRG, ZC, MSS: critical revision of the manuscript.
- Revised 2 April 2012
- Accepted 3 April 2012
- Published Online First 22 May 2012
Objective Previous investigations of short-term outcomes after preoperative exposure to biological therapy in inflammatory bowel disease (IBD) were conflicting. The authors aimed to assess postoperative outcomes in patients who underwent abdominal surgery with recent exposure to anti-tumour necrosis factor therapy.
Design A retrospective case-control study with detailed matching was performed for subjects with IBD with and without exposure to biologics within 180 days of abdominal surgery. Postoperative outcomes were compared between the groups.
Results 473 procedures were reviewed consisting of 195 patients with exposure to biologics and 278 matched controls. There were no significant differences in most postoperative outcomes such as: length of stay, fever (≥38.5°C), urinary tract infection, pneumonia, bacteraemia, readmission, reoperations and mortality. On univariate analysis, procedures on biologics had more wound infections compared with controls (19% vs 11%; p=0.008), but this was not significant in multivariate analysis. Concomitant therapy with biologics and thiopurines was associated with increased frequencies of urinary tract infections (p=0.0007) and wound infections (p=0.0045). Operations performed ≤14 days from last biologic dose had similar rates of infections and other outcomes when compared with those performed within 15–30 days or 31–180 days. Patients with detectable preoperative infliximab levels had similar rates of wound infection compared with those with undetectable levels (3/10 vs 0/9; p=0.21).
Conclusion Preoperative treatment with TNF-α antagonists in patients with IBD is not associated with most early postoperative complications. A shorter time interval from last biological dose is not associated with increased postoperative complications. In most cases, surgery should not be delayed, and appropriate biological therapy may be continued perioperatively.
- Biological therapy
- postoperative complications
- inflammatory bowel disease
- Crohn's disease
- ulcerative colitis
- genetic polymorphisms
- clinical trials
- IBD clinical
- Helicobacter pylori
- mucosal immunology
- health economics
- health outcomes
- health disparities
- health service research
- Crohns colitis
- 5-aminosalicylic Acid (5-ASA)
- inflammatory bowel disorders
- genetic testing
Funding MW was supported by a Fellowship Award from the Canadian Institute of Health Research, Canadian Association of Gastroenterology and the Crohn's and Colitis Foundation of Canada and by the Joseph Lebovic Charitable Foundation. MSS is supported in part by the Gale and Graham Wright Research Chair in Digestive Disease. Partial funding for this study was provided by the Zane Cohen Centre for Digestive Diseases.
Competing interests None.
Ethics approval Ethics approval was granted by Mount Sinai Hospital Research Ethics Board, Toronto, ON, Canada
Provenance and peer review Not commissioned; internally peer reviewed.