Amy L Lightner1, Nicholas P McKenna1, Chung Sang Tse2, Neil Hyman3, Radhika Smith3, Gayane Ovsepyan4, Phillip Fleshner4, Kristen Crowell5, Walter Koltun5, Marc Ferrante6, Andre D'Hoore7, Nathalie Lauwers7, Bram Verstockt6, Antonino Spinelli8, Francesca DiCandido8, Laura E Raffals9, Kellie L Mathis1, Edward V Loftus9. 1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. 2. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. 3. Division of Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA. 4. Division of Colon and Rectal Surgery, Cedars-Sinai, Los Angeles, CA, USA. 5. Division of Colon and Rectal Surgery, Pennsylvania State Hershey Medical Center, Hershey, PA, USA. 6. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 7. Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium. 8. Division of Colon and Rectal Surgery, Humanitas University, Rozzano, Milan, Italy. 9. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease [CD]. We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within the 12 weeks prior to an abdominal operation as compared with patients who received anti-tumor necrosis factor [TNF] agents. METHODS: A retrospective chart review of adults with CD who underwent an abdominal operation between January 1, 2015 and May 1, 2017 was performed across six sites. Surgical site infection [SSI] was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. RESULTS: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar, except anti-TNF patients were more likely to have received combination therapy with an immunomodulator [P = 0.006]. There were no significant differences in postoperative SSI [13% in ustekinumab versus 20% in anti TNF-treated patients, p = 0.61] or hospital readmission rates [18% versus 10%, respectively, p = 0.14], but ustekinumab-treated patients had a higher rate of return to the operating room [16% versus 5%; P = 0.01]. There were no significant predictors identified on multivariable analysis. CONCLUSIONS: Of the 44 patients with CD who received ustekinumab within the 12 weeks prior to a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.
BACKGROUND: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease [CD]. We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within the 12 weeks prior to an abdominal operation as compared with patients who received anti-tumor necrosis factor [TNF] agents. METHODS: A retrospective chart review of adults with CD who underwent an abdominal operation between January 1, 2015 and May 1, 2017 was performed across six sites. Surgical site infection [SSI] was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. RESULTS: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar, except anti-TNF patients were more likely to have received combination therapy with an immunomodulator [P = 0.006]. There were no significant differences in postoperative SSI [13% in ustekinumab versus 20% in anti TNF-treated patients, p = 0.61] or hospital readmission rates [18% versus 10%, respectively, p = 0.14], but ustekinumab-treated patients had a higher rate of return to the operating room [16% versus 5%; P = 0.01]. There were no significant predictors identified on multivariable analysis. CONCLUSIONS: Of the 44 patients with CD who received ustekinumab within the 12 weeks prior to a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.
Authors: Ravi S Shah; Salam Bachour; Xue Jia; Stefan D Holubar; Tracy L Hull; Jean-Paul Achkar; Jessica Philpott; Taha Qazi; Florian Rieder; Benjamin L Cohen; Miguel D Regueiro; Amy L Lightner; Benjamin H Click Journal: J Crohns Colitis Date: 2021-07-05 Impact factor: 9.071