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

Abstract

The impact of postoperative anti-TNF therapy on infectious complications following Crohn's disease surgery remains controversial. Use of anti-TNF therapy 2-4weeks postoperatively appears safe, but safety of use within 2weeks is unknown. We sought to evaluate the effect of anti-TNF therapy initiated within 2weeks of abdominal surgery in patients with Crohn's disease. 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 2weeks or between 2 and 4weeks postoperatively and to those without exposure using chi-squared and regression analysis. Three hundred thirty-one abdominal surgeries were included; 241 were without anti-TNF exposure, 46 received postoperative anti-TNF within 2weeks of surgery, and 44 received anti-TNF therapy 2-4weeks after surgery. Patients who received anti-TNF therapy within 2weeks of surgery, those initiated between 2 and 4weeks of surgery, and those who did not receive anti-TNF therapy within 4weeks 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. Use of early anti-TNF therapy within 2weeks or between 2 and 4weeks following abdominal surgery did not increase risk of postoperative surgical infections in Crohn's patients.