title: Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn's disease patients.
abstract: OBJECTIVE
  Anti-tumor necrosis factor (anti-TNF) therapy effects on postoperative complications in Crohn's disease (CD) patients are unclear. We examined a retrospective cohort to clarify this relationship.
  
  
  METHODS
  CD patients followed at a referral center between July 2004 and May 2011 who underwent abdominal surgery were identified. Postoperative complications (major infection, intra-abdominal abscess, peritonitis, anastomotic leak, wound infection, dehiscence, fistula, thrombotic, and death) were compared in patients exposed and unexposed to anti-TNF ≤8 weeks preoperatively. Demographics, surgical history, comorbidities, corticosteroid (CS) and immunomodulator use, Montreal classification, operative details, and preoperative nutritional status were assessed. Multivariate analysis measured the independent effect of preoperative anti-TNF on postoperative complications.
  
  
  RESULTS
  Overall, 325 abdominal surgeries were performed; 150 (46%) with anti-TNF ≤8 weeks before surgery. The anti-TNF group developed overall infectious (36% vs. 25%, P=0.05) and a trend toward surgical site complications (36% vs. 25%, P=0.10) more frequently. Major postoperative and intra-abdominal septic complications did not differ between groups. Multivariable analysis showed that preoperative anti-TNF was an independent predictor of overall infectious (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.18-5.03) and surgical site (OR 1.96; 95% CI 1.02-3.77) complications.
  
  
  CONCLUSIONS
  In a tertiary referral center, use of anti-TNF therapy in CD patients ≤8 weeks before intestinal resection or any intra-abdominal surgery was independently associated with increases in infectious and surgical complications.
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Syed
authors.forename: Raymond K
authors.initials: RK
authors.lastname: Cross
authors.forename: Mark H
authors.initials: MH
authors.lastname: Flasar
mesh_terms: D000005:Abdomen / Q000601:surgery; D000068879:Adalimumab; D000328:Adult; D057868:Anastomotic Leak; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000068582:Certolizumab Pegol; D015331:Cohort Studies; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D059413:Intraabdominal Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011092:Polyethylene Glycols / Q000009:adverse effects; D011183:Postoperative Complications; D012189:Retrospective Studies; D018805:Sepsis / Q000139:chemically induced; D013530:Surgical Wound Infection / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol