Anti‐<scp>TNF</scp> therapy is not associated with an increased risk of post‐colectomy complications, a population‐based study

Ward, Steve; Mytton, Jemma; Henderson, Louise M.; Amin, Verda; Tanner, J; Evison, Felicity; Radley, Simon

doi:10.1111/codi.13937

Cited by 18 publications

(31 citation statements)

References 34 publications

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“…The risk of postoperative infectious complications in patients receiving biologics with immunosuppressive function before surgery may be high. Recently, multiple studies (8–14) have evaluated the impact of preoperative biologic therapy on the incidence of complications after surgery for IBD, but the findings of these studies are not consistent. A systematic review has found that preoperative anti–TNF-α therapy modestly increases the risk of complications after intestinal surgery for either UC or CD (15).…”

Section: Introductionmentioning

confidence: 99%

Impact of Preoperative Nutritional Status on the Incidence Rate of Surgical Complications in Patients With Inflammatory Bowel Disease With Vs Without Preoperative Biologic Therapy: A Case-Control Study

Yamamoto

Shimoyama

Umegae

et al. 2019

Clin Transl Gastroenterol

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OBJECTIVES: A case-control study was undertaken to assess the impact of preoperative nutrition on surgical outcomes in patients with inflammatory bowel disease with vs without preoperative biologic therapy. METHODS: Seventy patients who had received biologic therapy within 8 weeks before undergoing resection for active ulcerative colitis (n = 34) or Crohn's disease (n = 36) were included (BIO group). The control group comprised 70 patients without exposure to biologics, selected based on 5 matching criteria: inflammatory bowel disease subtype (ulcerative colitis/Crohn's disease), age (≤ or >40 years), disease severity (moderate/severe), surgical approach (open/laparoscopic), and main surgical procedure. Poor nutrition was defined as the presence of at least one of the following criteria: weight loss >10%–15% within 6 months, body mass index <18.5 kg/m 2 , Subjective Global Assessment Grade C, or serum albumin <30 g/L. RESULTS: The proportion of patients with preoperative poor nutrition was 43% in the BIO and 33% in the control groups ( P = 0.22). The incidence of postoperative infectious complications (anastomotic leak, intra-abdominal abscess, enterocutaneous fistula, or wound infection) was 16% in the BIO and 14% in the control groups ( P = 0.81). In the BIO group, poor nutrition significantly increased the risk of infectious complications (27% vs 8% without poor nutrition, P = 0.03). In addition, in the control group, the incidence of infectious complications was higher in patients with poor nutrition, but not significantly (22% vs 11%, P = 0.21). DISCUSSION: Poor nutrition increases the risk of infectious complications after surgery. The detrimental effects of poor nutrition on postsurgical infection may be enhanced in patients who have received biologic therapy preoperatively.

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Section: Introductionmentioning

confidence: 99%

Impact of Preoperative Nutritional Status on the Incidence Rate of Surgical Complications in Patients With Inflammatory Bowel Disease With Vs Without Preoperative Biologic Therapy: A Case-Control Study

Yamamoto

Shimoyama

Umegae

et al. 2019

Clin Transl Gastroenterol

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“…Next, 44 publications were excluded after reviewing the full text. Finally, 27 publications were included in this review 13–39 . Ten publications focused on CD, 10 focused on UC and seven focused on mixed IBD.…”

Section: Resultsmentioning

confidence: 99%

“…Test for subgroup differences: Chi 2 = 3.00, df = 2 (P = 0.22); I 2 = 33.3% Wound infection. Among studies with a preoperative anti-TNF-a window within four weeks or more than four weeks, 27,32,39 the data revealed no significant difference in wound infection between the two cohorts (p ¼ 0.93; OR ¼ 0.98; 95% CI 0.57-1.68, I 2 ¼ 0%; Figure 6(b)).…”

Section: Within 8 Weeksmentioning

confidence: 97%

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Effects of preoperative anti‐tumour necrosis factor alpha infusion timing on postoperative surgical site infection in inflammatory bowel disease: A systematic review and meta‐analysis

et al. 2019

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Background Anti-tumour necrosis factor alpha agents (anti-TNF-α) have been widely used in patients with inflammatory bowel disease (IBD). However, few published meta-analyses have focused on timing of the last infusion before surgery. We evaluated the relationship between preoperative anti-TNF-α timing and postoperative surgical site infection to provide additional evidence for surgeons to choose appropriate dates for surgery. Methods We searched from inception until January 2019 for studies that documented postoperative complications of adults with IBD who underwent preoperative anti-TNF-α treatment. Primary outcomes of included studies were the odds ratios of preoperative anti-TNF-α time frames (4, 8 and 12 weeks). In addition, surgical site infection and its subtypes (anastomotic leakage, abscesses and wound infection) were analysed. Results Twenty-seven publications were included. No significant difference between anti-TNF-α and control cohorts was observed for most postoperative surgical site infections (or its subtypes) when the preoperative anti-TNF-α infusion time window was within 4, 8 or 12 weeks. Additionally, no significant difference in postoperative complications was observed between preoperative anti-TNF-α windows of within four weeks and more than four weeks. Conclusions In terms of surgical site infection and its subtypes, anti-TNF-α may be safe for ulcerative colitis and Crohn’s disease patients who receive their last infusion of anti-TNF-α more than four weeks before surgery. We also found no evidence that anti-TNF-α was a risk factor when administered within four weeks, with the exception of subgroup results from a single study. Stratified by time window, use of anti-TNF-α until surgery has the potential to become a more considered strategy in clinical practice.

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“…In this issue Ward et al . have made a large register based study of 6 225 patients with UC going through colectomy, comparing those with biologicals pre‐operatively (12%) with those not. No data regarding mortality is presented but biologicals were not found to be associated with an increased risk of post‐operative complications.…”

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Anti‐TNF therapy is not associated with an increased risk of post‐colectomy complications, a population‐based study

Cited by 18 publications

References 34 publications

Impact of Preoperative Nutritional Status on the Incidence Rate of Surgical Complications in Patients With Inflammatory Bowel Disease With Vs Without Preoperative Biologic Therapy: A Case-Control Study

Impact of Preoperative Nutritional Status on the Incidence Rate of Surgical Complications in Patients With Inflammatory Bowel Disease With Vs Without Preoperative Biologic Therapy: A Case-Control Study

Effects of preoperative anti‐tumour necrosis factor alpha infusion timing on postoperative surgical site infection in inflammatory bowel disease: A systematic review and meta‐analysis

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