Advertisement

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

  • Christine A. Schad
  • Bryce E. Haac
  • Raymond K. Cross
  • Ali Syed
  • Shumet Lonsako
  • Andrea C. BaffordEmail author
Original Article
  • 37 Downloads

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.

Keywords

Crohn’s disease Anti-TNF Postoperative Complications Infection 

Notes

Compliance with ethical standards

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.

References

  1. 1.
    Xavier RJ, Podolsky DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature. 2007;448:427–434.CrossRefGoogle Scholar
  2. 2.
    Braegger CP, Nicholls S, Murch SH, Stephens S, MacDonald TT. Tumour necrosis factor alpha in stool as a marker of intestinal inflammation. Lancet. 1992;339:89–91.CrossRefGoogle Scholar
  3. 3.
    Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. N Engl J Med. 1997;337:1029–1035.CrossRefGoogle Scholar
  4. 4.
    Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–1549.CrossRefGoogle Scholar
  5. 5.
    Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323–333.CrossRefGoogle Scholar
  6. 6.
    Regueiro M, Feagan BG, Zou B, et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection. Gastroenterology. 2016;150:1568–1578.CrossRefGoogle Scholar
  7. 7.
    Carla-Moreau A, Paul S, Roblin X, Genin C, Peyrin-Biroulet L. Prevention and treatment of postoperative Crohn’s disease recurrence with anti-TNF therapy: a meta-analysis of controlled trials. Dig Liver Dis. 2015;47:191–196.CrossRefGoogle Scholar
  8. 8.
    Regueiro M, Kip KE, Baidoo L, Swoger JM, Schraut W. Postoperative therapy with infliximab prevents long-term Crohn’s disease recurrence. Clin Gastroenterol Hepatol. 2014;12:1494–1502.CrossRefGoogle Scholar
  9. 9.
    Sorrentino D, Terrosu G, Avellini C, Beltrami CA, Bresadola V, Toso F. Prevention of postoperative recurrence of Crohn’s disease by infliximab. Eur J Gastroenterol Hepatol. 2006;18:457–459.CrossRefGoogle Scholar
  10. 10.
    Frolkis AD, Dykeman J, Negrón ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013;145:996–1006.CrossRefGoogle Scholar
  11. 11.
    Frolkis AD, Lipton DS, Fiest KM, et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol. 2014;109:1739.CrossRefGoogle Scholar
  12. 12.
    Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA. 2006;295:2275–2285.CrossRefGoogle Scholar
  13. 13.
    Ford AC, Peyrin-Biroulet L. Opportunistic infections with anti-tumor necrosis factor-α therapy in inflammatory bowel disease: meta-analysis of randomized controlled trials. Am J Gastroenterol. 2013;108:1268–1276.CrossRefGoogle Scholar
  14. 14.
    Colombel JF, Loftus EV Jr., Tremaine WJ, et al. Early postoperative complications are not increased in patients with crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99:878–883.CrossRefGoogle Scholar
  15. 15.
    Kunitake H, Hodin R, Shellito PC, et al. Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg. 2008;12:1730–1736 (discussion 1736–1737).CrossRefGoogle Scholar
  16. 16.
    Appau KA, Fazio VW, Shen B, et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn’s patients. J Gastrointest Surg. 2008;12:1738–1744.CrossRefGoogle Scholar
  17. 17.
    Syed A, Cross RK, Flasar MH. Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn’s disease patients. Am J Gastroenterol. 2013;108:583–593.CrossRefGoogle Scholar
  18. 18.
    Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther. 2004;19:749–754.CrossRefGoogle Scholar
  19. 19.
    Waterman M, Xu W, Dinani A, et al. Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease. Gut. 2013;62:387–394.CrossRefGoogle Scholar
  20. 20.
    Ahmed Ali U, Martin ST, Rao AD, Kiran RP. Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn’s disease. Dis Colon Rectum. 2014;57:663–674.CrossRefGoogle Scholar
  21. 21.
    Billioud V, Ford AC, Tedesco ED, Colombel JF, 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;7:853–867.CrossRefGoogle Scholar
  22. 22.
    Kopylov U, Ben-Horin S, Zmora O, et al. Anti-tumor necrosis factor and postoperative complications in Crohn’s disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2012;18:2404–2413.CrossRefGoogle Scholar
  23. 23.
    Yang ZP, Hong L, Wu Q, Wu KC, Fan DM. Preoperative infliximab use and postoperative complications in Crohn’s disease: a systematic review and meta-analysis. Int J Surg. 2014;12:224–230.CrossRefGoogle Scholar
  24. 24.
    Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–6.CrossRefGoogle Scholar
  25. 25.
    Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5–36.CrossRefGoogle Scholar
  26. 26.
    Regueiro M, El-Hachem S, Kip KE, et al. Postoperative infliximab is not associated with an increase in adverse events in Crohn’s disease. Dig Dis Sci. 2011;56:3610–3615.CrossRefGoogle Scholar
  27. 27.
    Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum. 2000;43:1141–1145.CrossRefGoogle Scholar
  28. 28.
    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;9:293–301.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christine A. Schad
    • 1
  • Bryce E. Haac
    • 1
  • Raymond K. Cross
    • 2
  • Ali Syed
    • 2
  • Shumet Lonsako
    • 2
  • Andrea C. Bafford
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Division of Gastroenterology, Department of MedicineUniversity of Maryland School of MedicineBaltimoreUSA

Personalised recommendations