Perioperative Anti-Tumor Necrosis Factor Alpha Agnents Do Not Increase the Rate of Early Postoperative Complications in Crohn's Disease
Basil S. Nasir*1, Eric J. Dozois1, Robert R. Cima1, John H. Pemberton1, Bruce G. Wolff1, William J. Sandborn2, Edward V. Loftus2, David W. Larson1
1Department of Surgery, Mayo Clinic, Rochester, MN; 2Department of Gastroenterology, Mayo Clinic, Rochester, MN
BACKGROUND: There have been numerous studies with conflicting results regarding the use of anti-tumor necrosis factor (TNF) alpha and its relationship to postoperative outcome. The aim of our study was to examine the rate of postoperative morbidity in patients receiving anti TNF alpha in the perioperative period.METHODS: All patients undergoing surgery for Crohn’s disease from 2005 till 2008 were abstracted from a prospective database. Patients who underwent surgery which included a suture or staple line at risk for leaking were selected for the study. A retrospective review of medical records was performed. The study group comprised patients treated with anti-TNF alpha within 8 weeks preoperatively or up to 30 days postoperatively. The remainder of the patients did not receive the drug in that time period. Patient characteristics, disease severity, medication use, operative intervention and 30-day complication were compared between the two groups. RESULTS: Three hundred and seventy patients were selected for analysis in this study, of which 119 received the drug within the allotted time period and 251 did not. The groups were similar in baseline characteristics, perioperative risk factors and procedures. The study group had more severe disease overall as measured by the American College of Gastroenterology (ACG) categories of disease (50% severe fulminant disease in the study group versus 18% in the unexposed group, p < 0.001). There was no significant association of anti-TNF alpha therapy and any postoperative complications (27.9% in study group versus 30.1% in unexposed group, p = 0.63) nor intra-abdominal infective complications (5.0% in study group versus 7.2% in unexposed group, p = 0.44). Univariate analysis showed that the only factors associated with an increase in postoperative intra-abdominal infections were age and penetrating disease.CONCLUSIONS: The use of anti-TNF alpha in the perioperative period is safe and does not seem to be associated with an increase in overall or infective complications for patients with Crohn's disease undergoing surgery.
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