Does preoperative biological therapy increase risk of postoperative complications in IBD patients?

Patients on biological therapy such as infliximab or adalimumab are at increased risk of infections and there is conflicting evidence that some IBD patients who had abdominal surgery with preoperative exposure to biologics do badly. In this issue of Gut, Waterman et al report postoperative outcomes in patients who underwent abdominal surgery with recent exposure to anti-tumour necrosis factor therapy. The authors conducted a retrospective case-control study with detailed matching for subjects with IBD with and without exposure to biologics within 180 days of abdominal surgery. Four hundred and seventy-three 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 (≥38.58°C), urinary tract infection, pneumonia, bacteraemia, readmission, reoperations and mortality. Concomitant therapy with biologics and thiopurines was associated with increased frequencies of urinary tract infections (p=0.0007) and wound infections (p=0.0045). …