Preoperative Use of Methotrexate and the Risk of Early Postoperative Complications in Patients with Inflammatory Bowel Disease

Afzali, Anita; Park, Christopher J.; Zhu, Kehao; Hu, Jie; Sharma, Prachi; Sinanan, Mika; Lee, Scott D.

doi:10.1097/mib.0000000000000780

Cited by 33 publications

(23 citation statements)

References 34 publications

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“…The only larger study explicitly looking at the impact of methotrexate on perioperative complications in IBD in 15 patients, 14 of these with Crohn's disease, showed no obvious correlation [12]. An additional meta-analysis in the same paper including this cohort and four other studies on rheumatoid arthritis confirmed this result.…”

Section: Perioperative Handling Of Medicationsupporting

confidence: 65%

Impact of Modern Drug Therapy on Surgery: Crohn's Disease

Kienle¹

2018

Visc Med

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Background: A significant number of patients with Crohn's disease needs to undergo surgery, and many of these patients are under modern drug treatment. These drugs may influence the rate of perioperative complications. This may have an impact on the chosen surgical strategy. Methods: This review considers clinical studies and guidelines on the effect of modern drug treatment on surgical complication rates and surgical strategy in patients with Crohn's disease. Results: Steroids above a certain dose significantly influence perioperative complications and should therefore be tapered down before performing elective surgery. Anti-TNF-alpha drugs are associated with perioperative complications, and therefore a safe interval between drug intake and surgery should be adhered to. The data on newer biologicals is scarce and conflicting; thus, it seems prudent to wait at least for one dosing interval before operating. In the emergency setting, patients undergoing bowel resection while on the above medications without an adequate interval to the last medication dose should generally get a resectional or diverting stoma. Conclusion: Modern drug treatment influences the surgical strategy in patients with Crohn's disease.

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Section: Perioperative Handling Of Medicationsupporting

confidence: 65%

Impact of Modern Drug Therapy on Surgery: Crohn's Disease

Kienle¹

2018

Visc Med

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“…Full-text articles excluded, with reasons (n = 16) Letter to the Editor (2) Biomarker stress response (1) Time to surgery (1) Delays in restarting meds (1) Post-op medication use only (4) No clear delineation of results (1) No ADR or complication reporting These data available on the outcomes of patients using TNF-a inhibitors perioperatively are conflicting. While many individual studies have shown that the use of TNF-a inhibitors before surgery increased postoperative complications, such as sepsis, anastomotic leak, and intraabdominal infections, other studies have shown that preoperative use did not increase the risk of postoperative complications [6,7,11,14,19,20,26,29,[34][35][36]40].…”

Section: Corticosteroidsmentioning

confidence: 99%

“…Hernigou et al [15] concluded that MTX and TNF-a inhibitors do not reduce survival time of a revised total knee arthroplasty in patients with RA compared with patients with osteoarthritis. Systematic reviews of retrospective studies concluded that MTX is safe to continue using in the perioperative period [4,12,30,33,46]. Afzali et al [4] included her own study in the meta-analysis; a retrospective study of patients on MTX therapy who underwent abdominal surgery for IBD.…”

Section: Methotrexatementioning

confidence: 99%

“…Systematic reviews of retrospective studies concluded that MTX is safe to continue using in the perioperative period [4,12,30,33,46]. Afzali et al [4] included her own study in the meta-analysis; a retrospective study of patients on MTX therapy who underwent abdominal surgery for IBD. Of 180 patients, only 15 patients who used MTX in the perioperative period were identified.…”

Section: Methotrexatementioning

confidence: 99%

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Systematic review of perioperative use of immunosuppressive agents in patients undergoing bariatric surgery

Kassel

Hutton

Zumach

et al. 2020

Surgery for Obesity and Related Diseases

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“…Another novel finding was the protective effect of 6-MP or MTX on the development of POI. All previous reports investigating the association of these immunomodulatory agents with increased postoperative complication rates in patients with IBD have been retrospective, with the two largest series focused on infectious complications without even mentioning POI in the analysis [21,22]. While animal studies have demonstrated the prokinetic effects of MTX [23], we await future studies on the mechanism of immunosuppressive agents on gut motility in IBD to validate our findings with a larger number of patients.…”

Section: Discussionmentioning

confidence: 71%

Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study

et al. 2020

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Background: Although biologic agents have revolutionized the medical management of severe ulcerative colitis (UC), there is considerable controversy regarding adverse effects of vedolizumab on surgical outcomes. We evaluated 30-day postoperative morbidity in UC patients undergoing abdominal colectomy (AC) treated with vedolizumab before surgery. Methods: From 2007 to 2017, 285 patients were enrolled in prospectively maintained database evaluating the role of clinical, serologic markers with clinical phenotypes in UC. The patients treated with vedolizumab within 12 weeks of AC was queried, then matched 1:3:3 into 3 preoperative treatment groups based on age, gender and surgical treatment of UC; ileal pouch-anal anastomosis (IPAA) with ileostomy vs total colectomy with end stoma: a) vedolizumab (n = 25); b) anti-tumor necrosis factor (anti-TNF) (n = 74); and c) no biologics (n = 54). Thirty-day postoperative complications among patient groups were compared. Results: The 3 patient groups were well-matched in other characteristics including disease duration, disease extent, medication history and preoperative serological data. There were no significant differences in the overall incidence of postoperative complications among patients treated preoperatively with vedolizumab, anti-TNFs, or no biologics (44% vs. 45% vs. 37%; p = 0.67). Although there was no significant difference between patient cohorts in infectious complications (p = 0.20), postoperative ileus (POI) was significantly more common among the vedolizumab group (n = 9; 36%) compared to anti-TNF (n = 12; 16%) or no biologics (n = 5; 9%) (p = 0.01). Multivariable analysis showed that vedolizumab treatment prior to surgery was an independent risk factor for POI (OR: 5.16, 95% CI; 1.71-15.52; p = .004). Conclusion: Although preoperative vedolizumab exposure did not influence the rate of overall 30-day postoperative complications, vedolizumab tends to increase incidence of POI.

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Preoperative Use of Methotrexate and the Risk of Early Postoperative Complications in Patients with Inflammatory Bowel Disease

Abstract: Preoperative MTX use does not seem to be associated with early postoperative complications in IBD.

Cited by 33 publications

References 34 publications

Impact of Modern Drug Therapy on Surgery: Crohn's Disease

Impact of Modern Drug Therapy on Surgery: Crohn's Disease

Systematic review of perioperative use of immunosuppressive agents in patients undergoing bariatric surgery

Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study

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