The Impact of Preoperative Anti-TNFα Therapy on Postoperative Outcomes Following Ileocolectomy in Crohn’s Disease

Afif N. Kulaylat, Audrey S. Kulaylat, Eric W. Schaefer, Katelin Mirkin, Andrew Tinsley, Emmanuelle Williams, Walter A. Koltun, Christopher S. Hollenbeak, Evangelos Messaris

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Controversy remains regarding the impact of anti-TNFα agents on postoperative outcomes in Crohn’s disease. Methods: Patients (≥ 18 years) with Crohn’s disease (ICD-9, 555.0–555.2, 555.9) undergoing ileocolectomy between 2005 and 2013 were identified using the Truven MarketScan® database and stratified by receipt of anti-TNFα therapy. Multivariable logistic regression was performed to evaluate anti-TNFα use on emergency department (ED) visits, postoperative complications, and readmissions at 30 days, adjusting for potential confounders. Relationships between timing of anti-TNFα administration and outcomes were examined. Results: The sample contained 2364 patients with Crohn’s disease undergoing ileocolectomy, with 28.5% (n = 674) who received biologic therapy. Median duration between anti-TNFα therapy and surgery was 33 days. Postoperative ED visits and readmission rates did not significantly differ among those receiving biologics and those that did not. Overall 30-day complication rates were higher among those receiving biologic therapy, namely related to wound and infectious complications. In multivariable analysis, anti-TNFα inhibitors were associated with increased odds of postoperative complications at 30 days (aggregate complications [OR 1.6], infectious complications [OR 1.5]). There was no significant association between timing of anti-TNFα administration and occurrence of postoperative outcomes. Conclusion: Anti-TNFα therapy is independently associated with increased postoperative infectious complications following ileocolectomy in Crohn’s disease. However, in patients receiving anti-TNFα therapy within 90 days of operative intervention, further delaying surgery may not attenuate risk of postoperative complications.

Original languageEnglish (US)
Pages (from-to)467-474
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume25
Issue number2
DOIs
StatePublished - Feb 2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

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