title: Tumor Necrosis Factor Alpha Inhibitors Did Not Influence Postoperative Morbidity After Elective Surgical Resections in Crohn's Disease.
abstract: The real impact of anti-tumor necrosis alpha (TNF) therapy in postoperative complications after intestinal resections in Crohn's disease (CD) still needs to be determined.
  
  
  
  To compare the postoperative complication rates after elective intestinal resections in CD patients, with or without previous exposure to anti-TNF therapy.
  
  
  
  This was a retrospective and observational study, with elective intestinal resections for CD (emergency procedures were excluded). Patients were allocated in two groups according to preoperative anti-TNF status. Surgical and medical complications were analyzed and subsequently compared between the groups.
  
  
  
  A total of 123 patients were included (71 with and 52 without preoperative anti-TNF). The groups were considered homogeneous, except for perianal CD, previous azathioprine, and stomas. There was no significant difference between the groups regarding overall surgical complications (32.69% in anti-TNF- vs. 39.44% in anti-TNF+ patients, p = 0.457) or overall medical complications (21.15 vs. 21.13%, respectively, p = 1.000). In univariate analysis, previous steroids, perianal CD, and stomas were considered risk factors for surgical complications, and previous steroids and hypoalbuminemia for medical complications. In multivariate analysis, previous steroids were associated with higher rates of surgical and medical complications, while hypoalbuminemia was associated with higher medical complication rates.
  
  
  
  There was no influence of the previous use of anti-TNF agents in postoperative surgical and medical complication rates in elective intestinal resections for CD. Previous steroids and hypoalbuminemia were associated with higher complication rates. This was the first case series of the literature describing outcomes in exclusively elective operations.
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Rua Bruno Filgueira, 369-cj, 1205, Curitiba, PR, CEP 80240-220, Brazil. pgkotze@hotmail.com.
authors.forename: Paulo Gustavo
authors.initials: PG
authors.lastname: Kotze
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Rua Bruno Filgueira, 369-cj, 1205, Curitiba, PR, CEP 80240-220, Brazil.
authors.forename: Mansur Paulo
authors.initials: MP
authors.lastname: Saab
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Rua Bruno Filgueira, 369-cj, 1205, Curitiba, PR, CEP 80240-220, Brazil.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Saab
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Rua Bruno Filgueira, 369-cj, 1205, Curitiba, PR, CEP 80240-220, Brazil.
authors.forename: Lorete Maria
authors.initials: LM
authors.lastname: da Silva Kotze
authors.affiliation: Biostatistics Department, Catholic University of Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, CEP 80215-901, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Olandoski
authors.affiliation: Colorectal Surgery Unit, Campinas State University (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil.
authors.forename: Lilian Vital
authors.initials: LV
authors.lastname: Pinheiro
authors.affiliation: Colorectal Surgery Unit, Campinas State University (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil.
authors.forename: Carlos Augusto Real
authors.initials: CA
authors.lastname: Martinez
authors.affiliation: Colorectal Surgery Unit, Campinas State University (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil.
authors.forename: Maria de Lourdes Setsuko
authors.initials: ML
authors.lastname: Ayrizono
authors.affiliation: Colorectal Surgery Unit, Campinas State University (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil.
authors.forename: Daniela de Oliveira
authors.initials: DO
authors.lastname: Magro
authors.affiliation: Colorectal Surgery Unit, Campinas State University (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil.
authors.forename: Claudio Saddy Rodrigues
authors.initials: CS
authors.lastname: Coy
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002432:Cecum / Q000601:surgery; D003082:Colectomy; D003424:Crohn Disease / Q000628:therapy*; D013505:Digestive System Surgical Procedures; D017558:Elective Surgical Procedures; D004766:Enterostomy; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D000069285:Infliximab / Q000627:therapeutic use*; D007415:Intestinal Obstruction / Q000453:epidemiology; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014552:Urinary Tract Infections / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Biological products; Crohn’s disease; Postoperative complications; Tumor necrosis factor alpha