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Early Postoperative Anti-TNF Therapy Does Not Increase Complications Following Abdominal Surgery in Crohn’s Disease

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Abstract

Background

The impact of postoperative anti-TNF therapy on infectious complications following Crohn’s disease surgery remains controversial. Use of anti-TNF therapy 2–4 weeks postoperatively appears safe, but safety of use within 2 weeks is unknown.

Aims

We sought to evaluate the effect of anti-TNF therapy initiated within 2 weeks of abdominal surgery in patients with Crohn’s disease.

Methods

We conducted a retrospective review of adult Crohn’s disease patients undergoing abdominal surgery between 2004 and 2011. Infectious and non-infectious complications were compared between patients exposed to anti-TNF therapy within 2 weeks or between 2 and 4 weeks postoperatively and to those without exposure using chi-squared and regression analysis.

Results

Three hundred thirty-one abdominal surgeries were included; 241 were without anti-TNF exposure, 46 received postoperative anti-TNF within 2 weeks of surgery, and 44 received anti-TNF therapy 2–4 weeks after surgery. Patients who received anti-TNF therapy within 2 weeks of surgery, those initiated between 2 and 4 weeks of surgery, and those who did not receive anti-TNF therapy within 4 weeks of surgery had no significant difference in rates of infectious complications (22%, 32%, 33%, p = 0.332). Rates of non-infectious complications (4%, 9%, 14%, p = 0.143), mortality (0%, 0%, 3%, p = 0.105), hospital readmission (17%, 16%, 15%, p = 0.940), and reoperation (11%, 11%, 16%, p = 0.563) were also similar between groups.

Conclusions

Use of early anti-TNF therapy within 2 weeks or between 2 and 4 weeks following abdominal surgery did not increase risk of postoperative surgical infections in Crohn’s patients.

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Authors and Affiliations

  1. Department of Surgery, University of Maryland School of Medicine, 29 South Greene Street, 6th Floor, Baltimore, MD, 21201, USA

    Christine A. Schad, Bryce E. Haac & Andrea C. Bafford

  2. Division of Gastroenterology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Raymond K. Cross, Ali Syed & Shumet Lonsako

Authors
  1. Christine A. Schad
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  2. Bryce E. Haac
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  3. Raymond K. Cross
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  4. Ali Syed
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  6. Andrea C. Bafford
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Corresponding author

Correspondence to Andrea C. Bafford.

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Conflict of interest

RK Cross has participated in advisory boards and has engaged in consulting with Abbvie, Janssen, Pfizer, and Takeda. RK Cross has research grants with Abbvie. No grant support was used in this project. The other authors have no potential conflicts of interest to disclose.

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Schad, C.A., Haac, B.E., Cross, R.K. et al. Early Postoperative Anti-TNF Therapy Does Not Increase Complications Following Abdominal Surgery in Crohn’s Disease. Dig Dis Sci 64, 1959–1966 (2019). https://doi.org/10.1007/s10620-019-5476-2

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  • DOI: https://doi.org/10.1007/s10620-019-5476-2

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