The Impact of Preoperative Anti-TNFα Therapy on Postoperative Outcomes Following Ileocolectomy in Crohn's Disease

J Gastrointest Surg. 2021 Feb;25(2):467-474. doi: 10.1007/s11605-019-04334-6. Epub 2020 Jan 21.

Abstract

Background: Controversy remains regarding the impact of anti-TNFα agents on postoperative outcomes in Crohn's disease.

Methods: Patients (≥ 18 years) with Crohn's disease (ICD-9, 555.0-555.2, 555.9) undergoing ileocolectomy between 2005 and 2013 were identified using the Truven MarketScan® database and stratified by receipt of anti-TNFα therapy. Multivariable logistic regression was performed to evaluate anti-TNFα use on emergency department (ED) visits, postoperative complications, and readmissions at 30 days, adjusting for potential confounders. Relationships between timing of anti-TNFα administration and outcomes were examined.

Results: The sample contained 2364 patients with Crohn's disease undergoing ileocolectomy, with 28.5% (n = 674) who received biologic therapy. Median duration between anti-TNFα therapy and surgery was 33 days. Postoperative ED visits and readmission rates did not significantly differ among those receiving biologics and those that did not. Overall 30-day complication rates were higher among those receiving biologic therapy, namely related to wound and infectious complications. In multivariable analysis, anti-TNFα inhibitors were associated with increased odds of postoperative complications at 30 days (aggregate complications [OR 1.6], infectious complications [OR 1.5]). There was no significant association between timing of anti-TNFα administration and occurrence of postoperative outcomes.

Conclusion: Anti-TNFα therapy is independently associated with increased postoperative infectious complications following ileocolectomy in Crohn's disease. However, in patients receiving anti-TNFα therapy within 90 days of operative intervention, further delaying surgery may not attenuate risk of postoperative complications.

Keywords: Biologic; Infection; Inflammatory bowel disease; Readmission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anastomosis, Surgical
  • Colectomy
  • Crohn Disease* / drug therapy
  • Crohn Disease* / surgery
  • Humans
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Period