Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn's disease patients

• Published in: The American journal of gastroenterology Vol. 108; no. 4; pp. 583 - 593
• Main Authors: Syed, Ali, Cross, Raymond K, Flasar, Mark H
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01-04-2013
• Subjects: Abdomen - surgery; Adalimumab; Adult; Anastomotic Leak; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Humanized - adverse effects; Certolizumab Pegol; Cohort Studies; Crohn Disease - surgery; Female; Gastroenterology; Humans; Immunoglobulin Fab Fragments - adverse effects; Immunosuppressive Agents - adverse effects; Infliximab; Intraabdominal Infections - etiology; Male; Middle Aged; Odds Ratio; Polyethylene Glycols - adverse effects; Postoperative Complications; Retrospective Studies; Sepsis - chemically induced; Surgical Wound Infection - etiology; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1038/ajg.2012.464

Anti-tumor necrosis factor (anti-TNF) therapy effects on postoperative complications in Crohn's disease (CD) patients are unclear. We examined a retrospective cohort to clarify this relationship.
CD patients followed at a referral center between July 2004 and May 2011 who underwent abdominal surgery were identified. Postoperative complications (major infection, intra-abdominal abscess, peritonitis, anastomotic leak, wound infection, dehiscence, fistula, thrombotic, and death) were compared in patients exposed and unexposed to anti-TNF ≤8 weeks preoperatively. Demographics, surgical history, comorbidities, corticosteroid (CS) and immunomodulator use, Montreal classification, operative details, and preoperative nutritional status were assessed. Multivariate analysis measured the independent effect of preoperative anti-TNF on postoperative complications.
Overall, 325 abdominal surgeries were performed; 150 (46%) with anti-TNF ≤8 weeks before surgery. The anti-TNF group developed overall infectious (36% vs. 25%, P=0.05) and a trend toward surgical site complications (36% vs. 25%, P=0.10) more frequently. Major postoperative and intra-abdominal septic complications did not differ between groups. Multivariable analysis showed that preoperative anti-TNF was an independent predictor of overall infectious (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.18-5.03) and surgical site (OR 1.96; 95% CI 1.02-3.77) complications.
In a tertiary referral center, use of anti-TNF therapy in CD patients ≤8 weeks before intestinal resection or any intra-abdominal surgery was independently associated with increases in infectious and surgical complications.