title: The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery.
abstract: OBJECTIVE
  Assess the impact of preoperative serum antitumor necrosis factor-α (anti-TNFα) drug levels on 30-day postoperative morbidity in inflammatory bowel disease (IBD) patients.
  
  
  BACKGROUND
  Studies on the association of anti-TNFα drugs and postoperative outcomes in IBD are conflicting due to variable pharmacokinetics of anti-TNFα drugs. It remains to be seen whether preoperative serum anti-TNFα drug levels correlate with postoperative morbidity.
  
  
  METHODS
  Thirty-day postoperative outcomes of consecutive IBD surgical patients with serum drawn within 7 days preoperatively were studied. The total serum level of 3 anti-TNFα drugs (infliximab, adalimumab, and certolizumab) was measured, with ≥ 0.98 μg/mL considered as detected. Data were also reviewed according to a clinical cutoff value of 3 μg/mL.
  
  
  RESULTS
  A total of 217 patients [123 with Crohn disease (CD) and 94 with ulcerative colitis (UC)] were analyzed; 75 of 150 (50%) treated with anti-TNFα therapy did not have detected levels at the time of surgery. In the UC cohort, adverse postoperative outcome rates between the undetectable and detectable groups were similar when stratified according to type of UC surgery. In the CD cohort, there was a higher but statistically insignificant rate of adverse outcomes in the detectable versus undetectable groups. Using a cut off level of 3 μg/mL, postoperative morbidity (odds ratio [OR] = 2.5, P = 0.03) and infectious complications (OR = 3.0, P = 0.03) were significantly higher in the ≥ 3 μg/mL group. There were higher rates of postoperative morbidity (P = 0.047) and hospital readmissions (P = 0.04) in the ≥ 8 μg/mL compared with <3 μg/mL group.
  
  
  CONCLUSIONS
  Increasing preoperative serum anti-TNFα drug levels are associated with adverse postoperative outcomes in CD but not UC patients.
authors.affiliation: *Division of Colorectal Surgery, Department of General Surgery †Department of Pediatrics ‡F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Lau
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.forename: Gil
authors.initials: G
authors.lastname: Melmed
authors.forename: Eric
authors.initials: E
authors.lastname: Vasiliauskas
authors.forename: Dror
authors.initials: D
authors.lastname: Berel
authors.forename: Dermot
authors.initials: D
authors.lastname: McGovern
authors.forename: Andrew
authors.initials: A
authors.lastname: Ippoliti
authors.forename: David
authors.initials: D
authors.lastname: Shih
authors.forename: Stephan
authors.initials: S
authors.lastname: Targan
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000097:blood* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000097:blood* / Q000627:therapeutic use; D000068582:Certolizumab Pegol; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005765:Gastrointestinal Agents / Q000097:blood* / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000097:blood* / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000601:surgery*; D000069285:Infliximab; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012042:Registries; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D007140:Immunoglobulin Fab Fragments; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol