Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery

Cohen, Benjamin L.; Fleshner, Phillip; Kane, Sunanda V.; Herfarth, Hans H; Palekar, Nicole; Farraye, Francis A.; Leighton, Jonathan A.; Katz, Jeffry; Cohen, Russell D.; Gerich, Mark E.; Cross, Raymond K.; Higgins, Peter; Tinsley, Andrew; Glover, Sarah C.; Siegel, Corey A.; Bohl, Jaime L.; Iskandar, Heba; Ji, Jiayi; Sands, Bruce E.

doi:10.1053/j.gastro.2022.03.057

Cited by 44 publications

(42 citation statements)

References 72 publications

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“…The investigators also measured serum anti-TNF levels preoperatively and found that detectable drug levels were not associated with infection or surgical site infection. 34 Serum levels of anti-TNF agents and preoperative anti-TNF agent use were not found to be associated with colectomy morbidity or postoperative complication rates. 35,36 A retrospective case-control study matching patients with IBD with and without exposure to preoperative anti-TNF biologics found that preoperative anti-TNF inhibitors and the time interval from the last dose of anti-TNF inhibitor were not associated with most early postoperative complications.…”

Section: Preoperative Periodmentioning

confidence: 86%

“…11 Recently, the PUCCINI trial was the first large prospective study examining preoperative anti-TNF therapy on surgical outcomes and showed that preoperative use of anti-TNF drugs in patients with IBD is not an independent risk factor for postoperative infections. 34 In this study, 947 patients were enrolled, of whom 382 were treated with anti-TNF drugs preoperatively. 34 The investigators found no significant difference in rates of infection (18.1% vs 20.2%; p = 0.469) or surgical site infections (12.0% vs 12.6%; p = 0.889) between patients exposed to TNF inhibitors and those unexposed.…”

Section: Preoperative Periodmentioning

confidence: 99%

“…34 In this study, 947 patients were enrolled, of whom 382 were treated with anti-TNF drugs preoperatively. 34 The investigators found no significant difference in rates of infection (18.1% vs 20.2%; p = 0.469) or surgical site infections (12.0% vs 12.6%; p = 0.889) between patients exposed to TNF inhibitors and those unexposed. 34 Multivariable analysis also found no significant differences in rates of infections.…”

Section: Preoperative Periodmentioning

confidence: 99%

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Perioperative Management of Ulcerative Colitis: A Systematic Review

Lee

Faye

Vermeire

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Patients with ulcerative colitis may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. Managing ulcerative colitis is complicated because there are many factors at play, including patient optimization and treatment, as the guidance varies on the ideal perioperative use of corticosteroids, immunomodulators, biologics, and small molecule agents. OBJECTIVE: A systematic literature review was performed to describe the current status of perioperative management of ulcerative colitis. DATA SOURCES: PubMed and Cochrane databases were used. STUDY SELECTION: Studies published between January 2000 and January 2022, in any language, were included. Articles regarding pediatric or endoscopic management were excluded. INTERVENTIONS: Perioperative management of ulcerative colitis was included. MAIN OUTCOME MEASURES: Successful management, including reducing surgical complication rates, was measured. RESULTS: A total of 121 studies were included in this review, including 23 meta-analyses or systematic reviews, 25 reviews, and 51 cohort studies. LIMITATIONS: Qualitative review including all study types. The varied nature of study types precludes quantitative comparison. CONCLUSION: Indications for colectomy in ulcerative colitis include severe disease unresponsive to medical treatment and colitis-associated neoplasia. Urgent colectomy has a higher mortality rate than elective colectomy. Corticosteroids are associated with postsurgical infectious complications and should be stopped or weaned before surgery. Biologics are not associated with adverse postoperative effects and do not necessarily need to be stopped preoperatively. Additionally, the clinician must assess individuals’ comorbidities, nutrition status, and risk of venous thromboembolism. Nutritional imbalance should be corrected, ideally at the preoperative period. Postoperatively, corticosteroids can be tapered on the basis of the length of preoperative corticosteroid use.

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Section: Preoperative Periodmentioning

confidence: 86%

Section: Preoperative Periodmentioning

confidence: 99%

Section: Preoperative Periodmentioning

confidence: 99%

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Perioperative Management of Ulcerative Colitis: A Systematic Review

Lee

Faye

Vermeire

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…In addition, TNF-α is a key cytokine in collagen production and angiogenesis, with animal studies confirming its role in wound healing[ 67 ]. However, previous studies have confirmed that preoperative TNFis exposure was not correlated with postoperative infectious complications[ 68 - 70 ] (Table 1 ).…”

Section: Clinical Factors Affecting Timing Of Surgerymentioning

confidence: 87%

Timing of individualized surgical intervention in Crohn’s disease

Xia¹,

Gao²,

Wu³

et al. 2022

World J Gastrointest Surg

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Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide. Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications. Surgical intervention plays a vital role in comprehensive therapy. However, deciding the optimal timing for surgical intervention has long been a focus of controversy. This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.

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“…[28][29][30][31][32][33] The recently published multicenter prospective PUCCINI study found that there was no increase in overall infection (OR, 1.050; 95% CI, 0.716-1.535) or surgical site infection (OR, 1.249; 95% CI, 0.793-1.960) in patients with inflammatory bowel disease undergoing intraabdominal surgery with preoperative anti-TNF-α exposure, compared with those without, though they did not look specifically at anastomotic leak rates. 34 Newer immunosuppressive agents target different pathways in the inflammatory process. Vedolizumab is a gutselective antibody that selectively targets the heterodimer α4β7 to VCAM-1.…”

Section: Medications -Corticosteroids Immunomodulators and Biologicsmentioning

confidence: 99%

Anastomotic Considerations in Crohn's Disease

Kann

2022

Clin Colon Rectal Surg

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A number of factors should be considered when performing an intestinal anastomosis in the setting of surgery for Crohn's disease. Preoperative risk factors, such as malnutrition, abdominal sepsis, and immunosuppressive medications, may increase the risk of postoperative anastomotic complications and alter surgical decision-making. The anatomical configuration and technique of constructing the anastomosis may have an impact on postoperative function and risk of recurrence, particularly in the setting of ileocolic resection, where the Kono-S anastomosis has gained popularity in recent years. There may be circumstances in which it may be more appropriate to perform an ostomy either without an anastomosis or to temporarily divert an anastomosis when the risk of anastomotic complications is felt to be high. In the setting of total abdominal colectomy or proctocolectomy for Crohn's colitis, restorative procedures may appropriate in lieu of a permanent stoma in certain scenarios.

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Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery

Cited by 44 publications

References 72 publications

Perioperative Management of Ulcerative Colitis: A Systematic Review

Perioperative Management of Ulcerative Colitis: A Systematic Review

Timing of individualized surgical intervention in Crohn’s disease

Anastomotic Considerations in Crohn's Disease

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