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THE IMPACT OF PERIOPERATIVE IMMUNOSUPPRESSION ON POST-SURGICAL OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Nicholas P. Valle
*1, Shaya Noorian
2, Alexandra C. Greb
1, Andrew R. Roney
1, Andrew T. Weber
3, Jenny S. Sauk
4, Mary Kwaan
1, Berkeley Limketkai
4,11Internal Medicine , University of California, Los Angeles, Los Angeles, CA; 2University of Maryland Medical System, Baltimore, MD; 3University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; 4University of California Los Angeles Division of Digestive Diseases, Los Angeles, CA
BACKGROUND: Patients with inflammatory bowel disease (IBD) often require immunosuppressive therapies; however, a significant proportion also need surgery for medication-refractory disease. While biologics appear safe perioperatively, evidence for them and other immunosuppressants remains limited. This study evaluates the impact of perioperative biologics, steroids, and immunomodulators on postoperative complications in IBD patients undergoing abdominal surgery.
METHODS: This retrospective study included adults with IBD who underwent bowel resection or revision surgery between 2010 and 2024 at a large tertiary-care academic center. Data were collected on patient demographics, IBD characteristics, surgical details, perioperative medication, and post-operative outcomes. Perioperative use of immunosuppressants was defined relative to surgery as: biologics -8 weeks to +4 weeks, steroids -4 weeks to +4 weeks, and immunomodulators -4 weeks to +4 weeks. Postoperative outcomes included 30-day surgical site infection, intraabdominal infection, urinary tract infection, sepsis, intrabdominal abscess, reoperation, readmission, and postoperative length of stay (LOS). Multivariable regressions evaluated the association between immunosuppressant classes and surgical outcomes, while adjusting for demographics, IBD type, surgical approach, elective surgery, and other potential confounders, including concomitant immunosuppressive therapy.
RESULTS: This study included 274 patients who underwent IBD-related surgery. Clinical and surgical characteristics are summarized in Table 1. Perioperative use of biologics was not associated with an increased risk of surgical complications (Table 2), but postoperative use was associated with 1.5 days (95% CI: -2.9 to -0.02) shorter LOS. Perioperative use of immunomodulators was associated with increased risk of intraabdominal infections (OR 3.6, 95% CI 1.1 to 12.0) and urinary tract infections (OR 4.3, 95% CI 1.2 to 15.9), but did not affect LOS (OR 0.1, 95% CI -1.4 to 1.3). Steroids were associated with a significantly increased risk of perioperative sepsis (OR 11.3, 95% CI 1.2 to 109.8) but also did not impact LOS (OR 0.5, 95% CI -0.9 to 1.8). No associations were observed between perioperative immunosuppression and other surgical complications (Table 2).
CONCLUSION: Consistent with the PUCCINI study, perioperative biologics were not associated with an increased postoperative complication and were instead associated with shorter length of hospital stay. In contrast, immunomodulators and steroids were associated with higher risks of infections. These findings build on the growing evidence showing the safety of biologic therapies perioperatively, while reminding clinicians of the need to remain judicious about the perioperative use of steroids and immunomodulators in surgical IBD patients.
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