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Preoperative biological therapy and outcomes of abdominal surgery in IBD

The latest issue of Gut investigates preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease.

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Previous investigations of short-term outcomes after preoperative exposure to biological therapy in inflammatory bowel disease were conflicting.

Dr Matti Watermans from Canada assessed postoperative outcomes in patients who underwent abdominal surgery with recent exposure to anti-tumor necrosis factor therapy.

The team performed a retrospective case-control study with detailed matching for subjects with inflammatory bowel disease with and without exposure to biologics within 180 days of abdominal surgery.

Postoperative outcomes were compared between the groups.

The doctors reported that results 473 procedures were reviewed consisting of 195 patients with exposure to biologics, and 278 matched controls.

There were no significant differences in most postoperative outcomes such as length of stay, fever, urinary tract infection, pneumonia, bacteraemia, readmission, reoperations and mortality.

Biologics with thiopurines was associated with increased urinary tract infections
Gut

The doctors found that procedures on biologics had more wound infections compared with controls, but this was not significant in multivariate analysis.

Concomitant therapy with biologics and thiopurines was associated with increased frequencies of urinary tract infections and wound infection.

The researchers noted that operations performed 14 days from last biologic dose had similar rates of infections and other outcomes when compared with those performed within 15–30 days or 31–180 days.

Patients with detectable preoperative infliximab levels had similar rates of wound infection compared with those with undetectable levels.

Waterman concluded "Preoperative treatment with TNF-α antagonists in patients with inflammatory bowel disease is not associated with most early postoperative complications."

"A shorter time interval from last biological dose is not associated with increased postoperative complications. In most cases, surgery should not be delayed, and appropriate biological therapy may be continued perioperatively."

Gut 2013; 62: 387-394
22 February 2013

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