title: Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience.
abstract: OBJECTIVE
  The impact of preoperative use of TNF-alpha inhibitors on postoperative complications in patients with inflammatory bowel disease (IBD) undergoing abdominal surgery is controversial. The aim of this study was to evaluate the 30-day postoperative outcomes for IBD patients treated with these drugs prior to surgery.
  
  
  METHODS
  We analyzed retrospectively the incidence of short-term postoperative complications. Statistical analyses were performed to reveal the independent variables that influenced postoperative complications and the role of preoperative medical therapy with anti-TNF drugs within 12 weeks prior to surgery.
  
  
  RESULTS
  One hundred fourteen patients (76 with Crohn's disease (CD) and 38 ulcerative colitis (UC)) underwent abdominal surgery for IBD. Fifty-four patients were treated with anti-TNF-alpha within 12 weeks prior to surgery (anti-TNF group). Postoperative mortality and morbidity were 0% and 21%, respectively. The infection rate was 15%. A significantly higher incidence of postoperative complications was found in patients treated with high-dose steroids (58% vs. 17%; p = 0.003) after univariate analysis. The infection rate was significantly higher in patients treated with high-dose corticosteroids (50% vs. 11%; p = 0.002) and concomitant anti-TNF-alpha (60% vs. 13%; p = 0.023). Multivariate analysis revealed that only therapy with high-dose corticosteroids was significantly associated with cumulative (p = 0.017) and infective postoperative complications (p = 0.046). No significant differences were found between the anti-TNF group and the control group.
  
  
  CONCLUSIONS
  High-dose corticosteroids increased the risk of short-term postoperative cumulative and infective complications. Anti-TNF drugs within 12 weeks prior to abdominal surgery in patients with IBD did not appear to increase the rate of postoperative complications.
authors: General Surgery Unit, Complesso Integrato Columbus, Catholic University, Via Moscati, 31, 00168, Rome, Italy. gianluca.rizzo1979@libero.it
authors: Gianluca
authors: G
authors: Rizzo
authors: Alessandro
authors: A
authors: Armuzzi
authors: Daniela
authors: D
authors: Pugliese
authors: Alessandro
authors: A
authors: Verbo
authors: Alfredo
authors: A
authors: Papa
authors: Claudio
authors: C
authors: Mattana
authors: Gian Lodovico
authors: GL
authors: Rapaccini
authors: Luisa
authors: L
authors: Guidi
authors: Claudio
authors: C
authors: Coco
references: J Am Coll Surg. 2007 May;204(5):956-62; discussion 962-3
references: 17481518
references: Dis Colon Rectum. 1993 Nov;36(11):1007-14
references: 8223051
references: Dig Liver Dis. 2008 Jul;40 Suppl 2:S271-9
references: 18599000
references: Semin Arthritis Rheum. 2005 Apr;34(5 Suppl1):12-8
references: 15852249
references: J Gastrointest Surg. 2008 Oct;12(10):1730-6; discussion 1736-7
references: 18709514
references: Ann Surg. 1991 Jan;213(1):37-42
references: 1985536
references: Aliment Pharmacol Ther. 2007 Sep 1;26(5):747-56
references: 17697208
references: Gastroenterology. 2007 Feb;132(2):763-86
references: 17258735
references: Dis Colon Rectum. 2007 Nov;50(11):1747-53
references: 17704969
references: Surg Endosc. 2010 Aug;24(8):1866-71
references: 20108148
references: Am J Gastroenterol. 2008 Sep;103(9):2373-81
references: 18616660
references: N Engl J Med. 2010 Apr 15;362(15):1383-95
references: 20393175
references: Gastroenterology. 2005 Jun;128(7):1805-11
references: 15940615
references: J Gastrointest Surg. 2008 Oct;12(10):1738-44
references: 18709420
references: J Crohns Colitis. 2008 Mar;2(1):24-62
references: 21172195
references: Am J Gastroenterol. 2004 May;99(5):878-83
references: 15128354
references: Dis Colon Rectum. 1996 May;39(5):504-8
references: 8620798
references: World J Surg. 2003 Dec;27(12):1306-10
references: 14716499
references: Inflamm Bowel Dis. 2002 Sep;8(5):311-6
references: 12479645
references: Aliment Pharmacol Ther. 2004 Apr 1;19(7):749-54
references: 15043515
references: J Crohns Colitis. 2010 Feb;4(1):28-62
references: 21122489
references: J Gastrointest Surg. 2002 Jul-Aug;6(4):606-13
references: 12127128
references: Inflamm Bowel Dis. 2009 Jul;15(7):1062-70
references: 19161179
references: J Gastrointest Surg. 2004 Jul-Aug;8(5):547-51
references: 15239989
references: Aliment Pharmacol Ther. 2010 Feb 15;31(4):486-92
references: 19925496
references: Aliment Pharmacol Ther. 2001 Apr;15(4):463-73
references: 11284774
references: N Engl J Med. 2005 Dec 8;353(23):2462-76
references: 16339095
references: Dis Colon Rectum. 2008 Aug;51(8):1202-7; discussion 1207-10
references: 18536964
references: Dis Colon Rectum. 2007 Mar;50(3):331-6
references: 17252288
references: Br J Surg. 1990 Oct;77(10):1175-8
references: 2224468
references: Gastroenterology. 2003 Aug;125(2):320-7
references: 12891531
references: Lancet. 2008 Feb 23;371(9613):660-667
references: 18295023
references: Rev Infect Dis. 1989 Nov-Dec;11(6):954-63
references: 2690289
references: Clin Gastroenterol Hepatol. 2008 Jun;6(6):644-53
references: 18550004
references: Dig Liver Dis. 2011 Jan;43(1):1-20
references: 20843756
references: Dis Colon Rectum. 2000 Aug;43(8):1141-5
references: 10950014
references: Int J Colorectal Dis. 2010 Mar;25(3):401-4
references: 19798508
references: Curr Opin Pharmacol. 2010 Jun;10(3):308-15
references: 20172761
references: Int J Colorectal Dis. 1994 May;9(2):73-6
references: 8064193