Association between preoperative biologic use and surgical morbidity in patients with Crohn’s disease

Uchino, Motoi; Ikeuchi, Hiroki; Horio, Yuki; Kuwahara, Ryuichi; Minagawa, Tomonori; Kusunoki, Kurando; Goto, Yoshiko; Beppu, Naohito; Ichiki, Kaoru; Nakajima, Kazuhiko; Ikeda, Masataka

doi:10.1007/s00384-022-04140-8

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…While there are no pediatric studies investigating the safety of preoperative ustekinumab, there have been no findings of increased risk in the adult population (12). Lightner initial study revealed no difference compared to anti-TNF and these results were similar in a recent study performed in Japan (16).…”

Section: Risk Factors For Surgical Complicationssupporting

confidence: 83%

“…The adult Post -Operative Infection in Inflammatory Bowel Disease (PUCCINI) study to identify risk factors for postoperative infection showed no difference in infection rates if exposed to anti-TNF 12 weeks prior to surgery and concluded that surgery should not be delayed in setting of preoperative biologic exposure (13,14). Further adult and small single-center pediatric studies also support the safety of biologics preoperatively (13)(14)(15)(16)(17).…”

Section: Preoperative Medicationmentioning

confidence: 98%

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Perioperative Management of Pediatric Crohn’s Disease

Pasternak

Patel

Tran

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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C rohn disease (CD) is a chronic inflammatory condition that may affect any part of the gastrointestinal tract. It is transmural in nature and complications such as fistula, strictures, and perianal disease may occur. There is more extensive anatomic involvement (50% ileocolonic, 20% colonic, 30% with upper Gastrointestinal (GI) symptoms) and a higher surgical risk in pediatrics than adults (50% vs 14% by age 30). Studies have shown 3.4%-7.9% of patients require surgery in first year after diagnosis, 13.8%-47.2% by 5 years, and 28%-35% by 10 years (1). There are 3 major surgical categories: ileocecal resection, treatment of complication, (fistula/stricture-Figures 1 and 2) or salvage procedure for severe refractory disease. In addition, surgery may be considered with active short segment disease or children illustrating poor growth despite optimized medical therapy European Society of Gastroenterology, Hepatology and Nutriiton (ESPGHAN). Unfortunately, much data on pediatrics is derived from single centers rather than population-based cohorts and the most recent societal reports were based on studies with minimal biologic use (18%-24%) (1). Despite larger use of biologics, resection is still needed in 20%-34%, thus effective perioperative management of pediatric CD is imperative (1). RISK FACTORS PREDICTING AGGRESSIVE DISEASEIn adults, early age of diagnosis (<40 years) and steroid use within first year of diagnosis have been identified as risk factors for more aggressive disease, indicating a clear need for separate pediatric criteria (1,2). Pediatric risk factors include complicated disease behavior, poor growth, ASCA positivity, NOD2 genotype, in addition to leukocytosis and hypoalbuminemia (Table 1) (1,3) Dubinsky et al (4) has shown that an increased risk of surgery is associated with number and magnitude of serologic markers. A recent consensus statement additionally described old age at presentation, small bowel disease, perianal disease, and ethnicity as risk factors for penetrating and/or stricturing disease (5). Isolated colonic disease was protective, as well as immunomodulator use within first 30 days, upper GI tract disease, and younger age at presentation (1,5).

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Section: Risk Factors For Surgical Complicationssupporting

confidence: 83%

Section: Preoperative Medicationmentioning

confidence: 98%

Perioperative Management of Pediatric Crohn’s Disease

Pasternak

Patel

Tran

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Discontinuation of chronic steroids in the preoperative setting has been postulated to lead to adrenal crisis and shock secondary to 1 3 and postoperative infections and complications [78,85,86]. Additionally, detectable VDZ levels at the time of surgery, whether high or low, were not associated with postoperative morbidity, ileus, wound infection, leakage, or readmission [87][88][89]. Therefore, the timing of surgery should not be affected by the administration of vedolizumab.…”

Section: Steroidsmentioning

confidence: 99%

Peri-Operative Optimization of Patients with Crohn’s Disease

Syed,

Nadeem,

Gardinier

et al. 2024

Curr Gastroenterol Rep

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Purpose of Review The management of patients with Crohn’s disease (CD) undergoing surgery is complex and optimization of modifiable factors perioperatively can improve outcomes. This review focuses on the perioperative management of CD patients undergoing surgery, emphasizing the need for a multi-disciplinary approach. Recent Findings Research highlights the benefits of a comprehensive strategy, involving nutritional optimization, psychological assessment, and addressing septic complications before surgery. Despite many CD patients being on immune-suppressing medications, studies indicate that most of these medications are safe to use and should not delay surgery. However, a personalized approach for each case is needed. Summary This review underscores the importance of multi-disciplinary team led peri-operative management of CD patients. We suggest that this can be done at a dedicated perioperative clinic for prehabilitation, with the potential to enhance outcomes for CD patients undergoing surgery.

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“…Moreover, 226 research studies were excluded after preliminary screening and review. Finally, after carefully reading, reviewing, and confirming the full text content, 9 studies [9][10][11][12][13][14][15][16][17] were eventually selected to underpin this meta-analysis. Detailed inclusion and exclusion process of the articles is shown in Figure 1.…”

Section: Studies Selectionmentioning

confidence: 99%

Systematic Review and Meta-Analysis: Association between Preoperative Ustekinumab and Surgical Complications in Crohn’s Disease Patients

Li,

Jiang,

Lou

et al. 2023

Eur Surg Res

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Introduction: The impact of ustekinumab (UST) therapy on surgical complications in patients with Crohn’s disease (CD) remains controversial. The aim of this meta-analysis is to explore the link between these two. Methods: Databases (PubMed, Web of Science, Cochrane, and Springer Link) were searched until April 2022. Studies of CD patients who received UST and no UST prior to surgery (including no biological therapy, anti-tumor necrosis factor-α [anti-TNF-α] agent, and vedolizumab [VDZ]) were included. Primary outcomes included overall complications, infectious complications, and noninfectious complications. Results: Nine studies totaling 3,225 CD patients were enrolled; 332 patients received UST treatment. There was no evidence of difference in the overall complications (odds ratio [OR] = 0.84, p = 0.37, 95% confidence interval [CI] = [0.57–1.23], I2 = 40%) between CD patients who had UST treatment preoperatively and those who had no UST treatment. There was no evidence of a difference in infectious complications (OR = 1.15, p = 0.35, 95% CI = [0.86–1.53], I2 = 2%). Additionally, there was no significant evidence of difference between these groups in terms of noninfectious complications and death. Specifically, there was no evidence of difference in overall complications, infection complications (including wound complications, sepsis, abscess, and anastomotic leakage), and noninfection complications (ileus, readmission, and return to operation), compared with no biological therapy and anti-TNF-α agents. At the same time, no significant evidence of difference was discovered in the comparison of preoperative UST and VDZ therapy in terms of overall complications, infectious complications (sepsis and abscess), and noninfectious complications (intestinal obstruction, readmission, and recovery surgery). Conclusion: In general, compared with other biological agents, preoperative use of UST in the treatment of CD patients is usually safe and does not increase surgical complications.

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Association between preoperative biologic use and surgical morbidity in patients with Crohn’s disease

Cited by 6 publications

References 21 publications

Perioperative Management of Pediatric Crohn’s Disease

Perioperative Management of Pediatric Crohn’s Disease

Peri-Operative Optimization of Patients with Crohn’s Disease

Systematic Review and Meta-Analysis: Association between Preoperative Ustekinumab and Surgical Complications in Crohn’s Disease Patients

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