Afif N Kulaylat1, Audrey S Kulaylat2, Eric W Schaefer3, Katelin Mirkin2, Andrew Tinsley4, Emmanuelle Williams4, Walter A Koltun2, Christopher S Hollenbeak5, Evangelos Messaris6. 1. Department of Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA. 2. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. 3. Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. 4. Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. 5. Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, State College, PA, USA. 6. Department of Surgery, Harvard Medical School Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. emessari@bidmc.harvard.edu.
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.
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.
Authors: L Marchal; G D'Haens; G Van Assche; S Vermeire; M Noman; M Ferrante; M Hiele; M Bueno De Mesquita; A D'Hoore; F Penninckx; P Rutgeerts Journal: Aliment Pharmacol Ther Date: 2004-04-01 Impact factor: 8.171
Authors: Stephen B Hanauer; Brian G Feagan; Gary R Lichtenstein; Lloyd F Mayer; S Schreiber; Jean Frederic Colombel; Daniel Rachmilewitz; Douglas C Wolf; Allan Olson; Weihang Bao; Paul Rutgeerts Journal: Lancet Date: 2002-05-04 Impact factor: 79.321
Authors: Richard A Hansen; Gerald Gartlehner; Gregory E Powell; Robert S Sandler Journal: Clin Gastroenterol Hepatol Date: 2007-05-04 Impact factor: 11.382
Authors: Laurent Peyrin-Biroulet; Edward V Loftus; Jean-Frederic Colombel; William J Sandborn Journal: Am J Gastroenterol Date: 2009-10-27 Impact factor: 10.864
Authors: Florian N Loch; Carsten Kamphues; Katharina Beyer; Frederick Klauschen; Christian Schineis; Benjamin Weixler; Johannes C Lauscher; Marc Dorenbeck; Christian Bayerl; Rolf Reiter Journal: Front Surg Date: 2022-05-13