Original Article

International Journal of Colorectal Disease

, Volume 26, Issue 11, pp 1435-1444

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

  • Gianluca RizzoAffiliated withGeneral Surgery Unit, Complesso Integrato Columbus, Catholic University Email author 
  • , Alessandro ArmuzziAffiliated withInternal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University
  • , Daniela PuglieseAffiliated withInternal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University
  • , Alessandro VerboAffiliated withGeneral Surgery Unit, Complesso Integrato Columbus, Catholic University
  • , Alfredo PapaAffiliated withInternal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University
  • , Claudio MattanaAffiliated withGeneral Surgery Unit, Complesso Integrato Columbus, Catholic University
  • , Gian Lodovico RapacciniAffiliated withInternal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University
  • , Luisa GuidiAffiliated withInternal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University
  • , Claudio CocoAffiliated withGeneral Surgery Unit, Complesso Integrato Columbus, Catholic University

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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.

Keywords

Anti-TNF-alpha drugs Corticosteroids Ulcerative colitis Crohn's disease Postoperative complications