Perioperative Management of Biologics: To Have or to Hold

Abstract

P erioperative use of biologics has been a highly debated topic. Concerns regarding wound healing and infection risk have driven many physicians to hold biologic therapies perioperatively. Despite an increase in recent research on this topic, guidelines have not been updated in over a decade. Furthermore, current guidelines have conflicting evidence regarding when biologics should be held before major surgical procedures. The British Association of Dermatologists recommends withholding biologics for 4 half-lives before a surgery; however, this, like many of the other associations, has not been updated to reflect more recent research. 1 With the increasing number and use of biologic therapies, it is important to establish management protocols for the perioperative use of these agents in patients undergoing surgical procedures. Research suggests that biologics before low-risk surgical procedures incur no increased risk to patients; thus, certain medications may be safely continued preoperatively. [2][3][4] Table 1 summarizes currently published research on this topic. In this article, we aim to discuss the recent evidence on the safety of perioperative biologic therapy before higher risk surgeries. We also aim to advocate for an update in the current management guidelines.