Abstract
Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.
Highlights
Inflammatory bowel disease (IBD) management completely changed after the approval by the European Medicines Agency (EMA) of the first anti-tumor necrosis factor (TNF) in 1999 [1]
Regarding the preoperative treatment for inflammatory bowel disease (IBD), biological therapy was not associated with postoperative complications in the multivariate analysis
Administration nor anti-TNF drug levels during the preoperative period was associated with postoperative complications in IBD; the complete withdrawal of biological therapy during the preoperative period is not necessary to reduce the frequency of postoperative complications [28,29]
Summary
Inflammatory bowel disease (IBD) management completely changed after the approval by the European Medicines Agency (EMA) of the first anti-tumor necrosis factor (TNF) in 1999 [1]. Biologics have increased the therapeutic armamentarium previously based on corticosteroids, immunomodulators and surgery. The development of these therapies exerted a positive impact on the natural history of IBD and an improvement in the control of inflammation [2]. Only a proportion of patients respond to medical therapy and surgery still has a fundamental role in the management of IBD [3]. The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC
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