Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators

Subramanian, Venkataraman; Pollok, Richard; Kang, Jin-Yong; Kumar, Devinder

doi:10.1002/bjs.5375

Cited by 91 publications

(46 citation statements)

References 36 publications

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“…72 Therefore, the current practice of some surgeons to discontinue azathioprine or 6-mercaptopurine for 1 week up to 3 months prior to elective abdominal surgery for CD may not be warranted. 67,73,74 …”

Section: Immunomodulatorsmentioning

confidence: 98%

“…Interestingly, while these medications may result in bone marrow suppression or leukopenia, they have not been demonstrated to increase perioperative infectious complications. 8,67,68,74 Cyclosporine has been used in the treatment of severe CUC that is refractory to intravenous steroids with some success. 75 It acts primarily on cell-mediated immunity, reducing T-cell function and side effects include opportunistic infections, nephrotoxicity, and hypertension.…”

Section: Immunomodulatorsmentioning

confidence: 99%

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Perioperative complications in inflammatory bowel disease

Beddy

Dozois

Pembérton

2011

Inflammatory Bowel Diseases

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Almost 50% of patients with inflammatory bowel disease (IBD) will undergo surgery for their disease at some stage of its clinical course. Complications seen following surgery may occur early or late in the postoperative period. Patient factors, including active inflammatory disease, malnutrition, and use of immunosuppressant medications, make these patients a challenging surgical group and at increased risk for surgical complications. The purpose of this review is to characterize the complications that are commonly seen following surgery in patients with IBD and to discuss the surgical and patient factors that may influence their development.

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Section: Immunomodulatorsmentioning

confidence: 98%

Section: Immunomodulatorsmentioning

confidence: 99%

Perioperative complications in inflammatory bowel disease

Beddy

Dozois

Pembérton

2011

Inflammatory Bowel Diseases

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“…In the past conventional therapies like steroids and immunomodulators were considered at risk for surgical patients in terms of sepsis, hemorrhage, and anastomotic leaks, especially with azathioprine. 4 The first article on postsurgery complications due to IFX reported the absence of such complications in patients with CD in terms of length of hospitalization and early or late infections. 5 A multivariate analysis of 100 patients with CD did not find major risks for patients treated with biologic therapies or immunomodulators prior to surgery.…”

Section: Casementioning

confidence: 99%

Combined approach with biologics and surgery for enterocutaneous fistulas in Crohnʼs disease

Fries

Malfa

Costantino

et al. 2011

Inflammatory Bowel Diseases

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“…However, immunomodulators such as azathioprine (AZA), cyclosporine A (CyA) and infliximab (IFX) were not indicated as risk factors [15,16] . Additionally, we previously determined that corticosteroids, but not immunomodulators and BIO, could be a risk factor for SSI [17] .…”

mentioning

confidence: 99%

Does Pre-Operative Multiple Immunosuppressive Therapy Associate with Surgical Site Infection in Surgery for Ulcerative Colitis?

Uchino

Ikeuchi²,

Bando³

et al. 2015

Digestion

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Background: Almost all surgeries for ulcerative colitis (UC) are performed under immunosuppressive conditions. Immunomodulators or biologics, with the exception of corticosteroids, do not appear to be risk factors for post-operative infectious complications. However, many patients are on multiagent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressives on the occurrence of surgical site infection (SSI) in UC. Methods: We reviewed surveillance data from 181 patients who underwent restorative proctocolectomy between January 2012 and March 2014. The incidences of SSI and the possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed. Results: The incidence of incisional (INC) SSI was 13.3% and that of organ/space (O/S) SSI was 7.2%. The number of immunosuppressives did not significantly correlate with each incidence. Total prednisolone administration ≥12,000 mg (OR 2.6) and an American Society of Anesthesiologists score ≥3 (OR 2.8) were shown to be independent risk factors for overall SSI, whereas corticosteroid use in INC SSI (OR 17.4) and severe disease (OR 5.2) and a large amount of blood loss (OR 3.9) in O/S SSI were identified as risk factors. Conclusion: Although a correlation between multiple immunosuppressive therapy and SSIs was not found, it is not recommended that all patients be treated with multiple immunosuppressive therapy. Treatment strategy should be applied based on the patient's condition.

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Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators

Abstract: Available evidence does not suggest an increased rate of postoperative complications associated with immunomodulator use.

Cited by 91 publications

References 36 publications

Perioperative complications in inflammatory bowel disease

Perioperative complications in inflammatory bowel disease

Combined approach with biologics and surgery for enterocutaneous fistulas in Crohnʼs disease

Does Pre-Operative Multiple Immunosuppressive Therapy Associate with Surgical Site Infection in Surgery for Ulcerative Colitis?

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