Managing Immunomodulators Perioperatively

  • David R. Rosen
  • Radhika K. Smith


With the westernization of industrialized societies, the incidence of inflammatory bowel disease (IBD) has drastically increased globally. With this rise in incidence, there has been a resultant rise in the number of patients on immunosuppressive medications [1]. Colorectal surgeons, therefore, must be well prepared for the potential perioperative complications associated with these medications. Immunomodulators (thiopurines, calcineurin inhibitors, and methotrexate) are one class of medication that is used quite frequently in the medical treatment of IBD. Intuitively, as these medications alter immune system function, they raise a theoretical concern of increased perioperative complication rate, particularly related to wound infection, anastomotic healing, and other infectious complications. In this chapter, we examine the literature pertinent to the timing of surgery in patients on immunomodulators and provide our recommendations for the management of these medications in the perioperative period.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David R. Rosen
    • 1
  • Radhika K. Smith
    • 2
  1. 1.Cleveland ClinicClevelandUSA
  2. 2.Washington University at St. LouisSt. LouisUSA

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