title: Anti-Tumor Necrosis Factor-α Antibody Therapy Management Before and After Intestinal Surgery for Inflammatory Bowel Disease: A CCFA Position Paper.
abstract: Biologic therapy with anti-tumor necrosis factor (TNF)-α antibody medications has become part of the standard of care for medical therapy for patients with inflammatory bowel disease and may help to avoid surgery in some. However, many of these patients will still require surgical intervention in the form of bowel resection and anastomosis or ostomy formation for the treatment of their disease. Postsurgical studies suggest up to 30% of patients with inflammatory bowel disease may be on or have used anti-TNF-α antibody medications for disease management preoperatively. Significant controversy exists regarding the potential deleterious impact of these medications on the outcomes of surgery, specifically overall and/or infectious complications. In this position statement, we systematically reviewed the literature regarding the potential risk of anti-TNF-α antibody use in the perioperative period, offer recommendations based both on the best-available evidence and expert opinion on the use and timing of anti-TNF-α antibody therapy in the perioperative period, and discuss whether or not the presence of these medications should lead to an alteration in surgical technique such as temporary stoma formation.
authors.affiliation: *Division of Colon & Rectal Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; †Division of Colon & Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‡Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland; and §Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
authors.forename: Jennifer
authors.initials: J
authors.lastname: Holder-Murray
authors.forename: Mark
authors.initials: M
authors.lastname: Flasar
authors.forename: Mark
authors.initials: M
authors.lastname: Lazarev
mesh_terms: D013505:Digestive System Surgical Procedures; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000601:surgery / Q000628:therapy*; D000069285:Infliximab / Q000008:administration & dosage* / Q000009:adverse effects; D059035:Perioperative Period; D011183:Postoperative Complications; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab