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

  • Gianluca Rizzo
  • Alessandro Armuzzi
  • Daniela Pugliese
  • Alessandro Verbo
  • Alfredo Papa
  • Claudio Mattana
  • Gian Lodovico Rapaccini
  • Luisa Guidi
  • Claudio Coco
Original Article

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 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Gianluca Rizzo
    • 1
  • Alessandro Armuzzi
    • 2
  • Daniela Pugliese
    • 2
  • Alessandro Verbo
    • 1
  • Alfredo Papa
    • 2
  • Claudio Mattana
    • 1
  • Gian Lodovico Rapaccini
    • 2
  • Luisa Guidi
    • 2
  • Claudio Coco
    • 1
  1. 1.General Surgery UnitComplesso Integrato Columbus, Catholic UniversityRomeItaly
  2. 2.Internal Medicine and Gastroenterology UnitComplesso Integrato Columbus, Catholic UniversityRomeItaly

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