Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab.

Aims: To evaluate the impact of biologics on the risk of PC.

Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered "exposed". The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis.

Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2-2.0), urgent surgery (OR: 1.6; 95% CI: 1.2-2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1-1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3-2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97-1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03-2.27).

Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.

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References

Shah R, Bachour S, Jia X, Holubar S, Hull T, Achkar J . Hypoalbuminaemia, Not Biologic Exposure, Is Associated with Postoperative Complications in Crohn's Disease Patients Undergoing Ileocolic Resection. J Crohns Colitis. 2021; 15(7):1142-1151. PMC: 8427722. DOI: 10.1093/ecco-jcc/jjaa268. View

Bischoff S, Escher J, Hebuterne X, Klek S, Krznaric Z, Schneider S . ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clin Nutr. 2020; 39(3):632-653. DOI: 10.1016/j.clnu.2019.11.002. View

Huang W, Tang Y, Nong L, Sun Y . Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn's disease: A meta-analysis of observational studies. J Crohns Colitis. 2015; 9(3):293-301. DOI: 10.1093/ecco-jcc/jju028. View

Lightner A, Mathis K, Tse C, Pemberton J, Shen B, Kochhar G . Postoperative Outcomes in Vedolizumab-Treated Patients Undergoing Major Abdominal Operations for Inflammatory Bowel Disease: Retrospective Multicenter Cohort Study. Inflamm Bowel Dis. 2018; 24(4):871-876. DOI: 10.1093/ibd/izx076. View

Aberra F, Lewis J, Hass D, Rombeau J, Osborne B, Lichtenstein G . Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology. 2003; 125(2):320-7. DOI: 10.1016/s0016-5085(03)00883-7. View

Ferrante M, de Buck van Overstraeten A, Schils N, Moens A, Van Assche G, Wolthuis A . Perioperative Use of Vedolizumab is not Associated with Postoperative Infectious Complications in Patients with Ulcerative Colitis Undergoing Colectomy. J Crohns Colitis. 2017; 11(11):1353-1361. DOI: 10.1093/ecco-jcc/jjx095. View

Subramanian V, Pollok R, Kang J, Kumar D . Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg. 2006; 93(7):793-9. DOI: 10.1002/bjs.5375. View

Subramanian V, Saxena S, Kang J, Pollok R . Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol. 2008; 103(9):2373-81. DOI: 10.1111/j.1572-0241.2008.01942.x. View

Nunes T, Etchevers M, Merino O, Gallego S, Garcia-Sanchez V, Marin-Jimenez I . Does smoking influence Crohn's disease in the biologic era? The TABACROHN study. Inflamm Bowel Dis. 2012; 19(1):23-9. DOI: 10.1002/ibd.22959. View

10.

Shim H, Ma C, Kotze P, Panaccione R . Pre-operative Exposure to Ustekinumab: A Risk Factor for Postoperative Complications in Crohn's Disease (CD)?. Curr Drug Targets. 2019; 20(13):1369-1372. DOI: 10.2174/1389450120666190515094435. View

11.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

12.

Portela F, Lago P, Cotter J, Goncalves R, Vasconcelos H, Ministro P . Anaemia in Patients with Inflammatory Bowel Disease - A Nationwide Cross-Sectional Study. Digestion. 2016; 93(3):214-20. DOI: 10.1159/000443927. View

13.

Patel S, Patel M, Goldfarb M, Ortega A, Ault G, Kaiser A . Elective versus emergency surgery for ulcerative colitis: a National Surgical Quality Improvement Program analysis. Am J Surg. 2013; 205(3):333-7. DOI: 10.1016/j.amjsurg.2012.10.014. View

14.

Bouguen G, Peyrin-Biroulet L . Surgery for adult Crohn's disease: what is the actual risk?. Gut. 2011; 60(9):1178-81. DOI: 10.1136/gut.2010.234617. View

15.

Present D, Rutgeerts P, Targan S, Hanauer S, Mayer L, van Hogezand R . Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999; 340(18):1398-405. DOI: 10.1056/NEJM199905063401804. View

16.

Michailidou M, Nfonsam V . Preoperative anemia and outcomes in patients undergoing surgery for inflammatory bowel disease. Am J Surg. 2017; 215(1):78-81. DOI: 10.1016/j.amjsurg.2017.02.016. View

17.

Kim J, Zaghiyan K, Lightner A, Fleshner P . Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study. BMC Surg. 2020; 20(1):46. PMC: 7059353. DOI: 10.1186/s12893-020-00698-8. View

18.

Moosvi Z, Duong J, Bechtold M, Nguyen D . Systematic Review and Meta-Analysis: Preoperative Vedolizumab and Postoperative Complications in Patients with IBD. South Med J. 2021; 114(2):98-105. DOI: 10.14423/SMJ.0000000000001214. View

19.

Liang H, Jiang B, Manne S, Lissoos T, Bennett D, Dolin P . Risk factors for postoperative infection after gastrointestinal surgery among adult patients with inflammatory bowel disease: Findings from a large observational US cohort study. JGH Open. 2018; 2(5):182-190. PMC: 6207009. DOI: 10.1002/jgh3.12072. View

20.

Billioud V, Ford A, Del Tedesco E, Colombel J, Roblin X, Peyrin-Biroulet L . Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis. 2013; 7(11):853-67. DOI: 10.1016/j.crohns.2013.01.014. View