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Preoperative biologics did not increase IBD patients’ risks for most postsurgical complications
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Patients with IBD exposed to biologics before abdominal surgery were not found at increased risk for most postoperative complications, according to recent study results.
In a retrospective case-control study, researchers evaluated data from 473 patients with IBD who underwent abdominal surgery, including 195 patients exposed to infliximab or adalimumab less than 180 days before their procedures, and 278 matched controls. Complications observed within 30 days following the surgeries were recorded to determine if biologic therapy increased the incidence of adverse events.
Length of stay, readmission, reoperations, mortality and incidences of fever, urinary tract infection, pneumonia and bacteremia were not significantly associated with biologics exposure. Univariate analysis indicated that wound infections were more common among patients exposed to biologics compared with controls (19% vs. 11%, P=.008), but this significance was not maintained in multivariate analysis. Urinary tract and wound infections were significantly more common among patients receiving biologics and thiopurines (n=70, P=.0007 and .0045, respectively) than in matched controls (n=96). Bacteremia (P=.04) and antibiotic necessity after surgery (P=.02) also were more common in the combination therapy subgroup.
Investigators also examined the effect of time interval between patients’ final biologic doses and surgeries. Fifty-six patients underwent surgery within 14 days of their last dose, 48 patients within 15 days to 30 days and 89 patients within 31 days to 180 days. Rates of postoperative complications were similar in patients who underwent surgery 14 days or less to those in patients whose procedures were performed within 15 days to 30 days or 31 days to 180 days. Patients with detectable infliximab levels before surgery had similar wound infection rates to those without (3/10 vs. 0/9, P=.21).
“In a large cohort of patients with IBD who underwent abdominal surgery, preoperative biological therapy, regardless of the time interval from surgery, was not associated with postoperative infectious complications, anastomostic leaks and other peri-operative complications,” the researchers concluded. “Our findings do not support the practice of some physicians to delay surgery until anti-TNF-alpha antagonists agents are ‘washed out.’ Based on these results, we do not recommend altering anti-TNF therapy or the scheduling of surgery to prolong the time interval to operation.”
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