Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease

Law, Cindy; Koh, Deborah; Bao, Yueyang; Jairath, Vipul; Narula, Neeraj

doi:10.1002/14651858.cd013256

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…Regarding postoperative infections, the exposure to biological therapy seemed to be an independent risk factor in our patient cohort, although the results only reached borderline statistical significance. A recent meta-analysis revealed a slightly higher incidence of infections in patients under anti-TNF therapy, although this effect was not observed for vedolizumab [36,37]. Discordance of results for anti-TNF agents could be influenced by therapeutic plasma concentrations of anti-TNF at the time of surgery [38].…”

Section: Discussionmentioning

confidence: 99%

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

García¹,

Rivero²,

Miranda-Bautista³

et al. 2021

JCM

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Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusion: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.

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Section: Discussionmentioning

confidence: 99%

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

García¹,

Rivero²,

Miranda-Bautista³

et al. 2021

JCM

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“…Advances in biological therapies have had a major impact on the management of IBD in recent decades. These agents have reduced and/or delayed the need for surgery and are contributing to improving life expectancy 6,7 . Due to the inflammatory nature of the disease and need for immune suppressive therapies and surgical interventions, complications requiring hospitalisation are common 8 …”

Section: Introductionmentioning

confidence: 99%

Excess burden of critical illness related to inflammatory bowel disease

Laupland

Shekar

Tabah

et al. 2022

Internal Medicine Journal

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Background Although inflammatory bowel disease (IBD) is associated with major morbidity and mortality, few studies have evaluated its associated burden of critical illness. Aims To examine the epidemiology and outcome of intensive care unit (ICU) admission among patients with IBD in North Brisbane, Australia. Methods A population‐based cohort design was used. All admissions to ICU serving the Metro North Hospital and Health Service among adult residents during 2017–2019 were included. Data were obtained from ICU clinical information systems with linkages to statewide admissions and death registries. Results Among 9011 ICU admissions, 101 (1.1%) were among patients with IBD, of which 57 (0.6%) and 44 (0.5%) had ulcerative colitis (UC) and Crohn disease (CD) respectively. The incidence of ICU admission was 379, 1336, 1514 and 1429 per 100 000 annually among those without IBD, CD, UC and IBD respectively. Patients with IBD were at excess risk for admission across all age groups, with women aged <50 years at highest risk and men thereafter. The all‐cause 90‐day case‐fatality rates following ICU admission were not significantly different among patient groups and were 18%, 12%, 15% and 12% for CD, UC, IBD and non‐IBD respectively. However, as compared with non‐IBD patients, those with CD (151.8 vs 39.4 per 100 000; relative risk (RR) 3.85; 95% confidence interval (CI) 1.25–9.02; P = 0.013), UC (159.4 vs 39.4 per 100 000; RR 4.05; 95% CI 1.48–8.84; P = 0.005) and IBD (155.6 vs 39.4 per 100 000; RR 3.95; 95% CI 1.96–7.10; P = 0.002) were at significantly higher risk for mortality. Conclusions Patients with IBD suffer a major burden of critical illness.

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“…26 A systematic review and meta-analysis of 63 studies of medical therapies in IBD showed that the use of corticosteroids increases the risk of postoperative infectious complications (OR = 1.34; 95% CI, 1.25-1.44). 27 Infectious complications included wound infections and dehiscence, sepsis, pneumonia, peritonitis, abdominal abscess, urinary tract infections, and fever >101.5°F without an identifiable source. 26 Studies included in our review are outlined in Table 1.…”

Section: S8mentioning

confidence: 99%

“…Immunomodulators, such as azathiopurine, 6-mercaptopurine, and methotrexate, have been used in maintenance as monotherapy or part of combination therapy with anti-tumor necrosis factor (TNF). The preoperative use of immunomodulators does not seem to increase the risk for postinfectious complications in IBD; 27 however, the role of immunomodulators in the management of ASUC and in patients with refractory UC undergoing colectomy is limited.…”

Section: Preoperative Immunomodulatorsmentioning

confidence: 99%

“…[31][32][33][65][66][67][68] A systematic review and meta-analysis of 63 studies of medical therapies in IBD showed that the use of anti-TNF biologics increases the risk of postoperative infectious complications (OR = 1.26; 95% CI, 1.07-1.50). 27 The ECCO guidelines listed that patients on biologics might be at increased risk of developing early and late pouch-specific complications. 11 Recently, the PUCCINI trial was the first large prospective study examining preoperative anti-TNF therapy on surgical outcomes and showed that preoperative use of anti-TNF drugs in patients with IBD is not an independent risk factor for postoperative infections.…”

Section: Preoperative Use Of Biologicsmentioning

confidence: 99%

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Perioperative Management of Ulcerative Colitis: A Systematic Review

Lee

Faye

Vermeire

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Patients with ulcerative colitis may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. Managing ulcerative colitis is complicated because there are many factors at play, including patient optimization and treatment, as the guidance varies on the ideal perioperative use of corticosteroids, immunomodulators, biologics, and small molecule agents. OBJECTIVE: A systematic literature review was performed to describe the current status of perioperative management of ulcerative colitis. DATA SOURCES: PubMed and Cochrane databases were used. STUDY SELECTION: Studies published between January 2000 and January 2022, in any language, were included. Articles regarding pediatric or endoscopic management were excluded. INTERVENTIONS: Perioperative management of ulcerative colitis was included. MAIN OUTCOME MEASURES: Successful management, including reducing surgical complication rates, was measured. RESULTS: A total of 121 studies were included in this review, including 23 meta-analyses or systematic reviews, 25 reviews, and 51 cohort studies. LIMITATIONS: Qualitative review including all study types. The varied nature of study types precludes quantitative comparison. CONCLUSION: Indications for colectomy in ulcerative colitis include severe disease unresponsive to medical treatment and colitis-associated neoplasia. Urgent colectomy has a higher mortality rate than elective colectomy. Corticosteroids are associated with postsurgical infectious complications and should be stopped or weaned before surgery. Biologics are not associated with adverse postoperative effects and do not necessarily need to be stopped preoperatively. Additionally, the clinician must assess individuals’ comorbidities, nutrition status, and risk of venous thromboembolism. Nutritional imbalance should be corrected, ideally at the preoperative period. Postoperatively, corticosteroids can be tapered on the basis of the length of preoperative corticosteroid use.

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Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease

Cited by 12 publications

References 21 publications

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Excess burden of critical illness related to inflammatory bowel disease

Perioperative Management of Ulcerative Colitis: A Systematic Review

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