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Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience

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Abstract

Purpose

The impact of preoperative use of TNF-alpha inhibitors on postoperative complications in patients with inflammatory bowel disease (IBD) undergoing abdominal surgery is controversial. The aim of this study was to evaluate the 30-day postoperative outcomes for IBD patients treated with these drugs prior to surgery.

Methods

We analyzed retrospectively the incidence of short-term postoperative complications. Statistical analyses were performed to reveal the independent variables that influenced postoperative complications and the role of preoperative medical therapy with anti-TNF drugs within 12 weeks prior to surgery.

Results

One hundred fourteen patients (76 with Crohn's disease (CD) and 38 ulcerative colitis (UC)) underwent abdominal surgery for IBD. Fifty-four patients were treated with anti-TNF-alpha within 12 weeks prior to surgery (anti-TNF group). Postoperative mortality and morbidity were 0% and 21%, respectively. The infection rate was 15%. A significantly higher incidence of postoperative complications was found in patients treated with high-dose steroids (58% vs. 17%; p = 0.003) after univariate analysis. The infection rate was significantly higher in patients treated with high-dose corticosteroids (50% vs. 11%; p = 0.002) and concomitant anti-TNF-alpha (60% vs. 13%; p = 0.023). Multivariate analysis revealed that only therapy with high-dose corticosteroids was significantly associated with cumulative (p = 0.017) and infective postoperative complications (p = 0.046). No significant differences were found between the anti-TNF group and the control group.

Conclusion

High-dose corticosteroids increased the risk of short-term postoperative cumulative and infective complications. Anti-TNF drugs within 12 weeks prior to abdominal surgery in patients with IBD did not appear to increase the rate of postoperative complications.

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Conflict of interest

Alessandro Armuzzi has received consulting fees from Schering Plough and Abbott. He reports participation in continuing medical education events sponsored by Schering Plough, Abbott, Chiesi, Ferring, and Nycomed. Luisa Guidi reports participation in continuing medical education sponsored by Schering Plough and Abbott. No conflict of interest exists for the other authors. The study has been conducted in accordance with the Declaration of Helsinki.

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Authors and Affiliations

  1. General Surgery Unit, Complesso Integrato Columbus, Catholic University, Via Moscati, 31, 00168, Rome, Italy

    Gianluca Rizzo, Alessandro Verbo, Claudio Mattana & Claudio Coco

  2. Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy

    Alessandro Armuzzi, Daniela Pugliese, Alfredo Papa, Gian Lodovico Rapaccini & Luisa Guidi

Authors
  1. Gianluca Rizzo
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  2. Alessandro Armuzzi
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  3. Daniela Pugliese
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  4. Alessandro Verbo
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  5. Alfredo Papa
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  6. Claudio Mattana
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  7. Gian Lodovico Rapaccini
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  9. Claudio Coco
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Correspondence to Gianluca Rizzo.

Additional information

Gianluca Rizzo and Alessandro Armuzzi contributed equally to this study.

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Rizzo, G., Armuzzi, A., Pugliese, D. et al. Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience. Int J Colorectal Dis 26, 1435–1444 (2011). https://doi.org/10.1007/s00384-011-1236-2

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  • DOI: https://doi.org/10.1007/s00384-011-1236-2

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