Pre‐operative use of anti‐TNF‐α agents and the risk of post‐operative complications in patients with Crohn's disease – a nationwide cohort study

• Published in: Alimentary pharmacology & therapeutics 2013-01, Vol.37 (2), p.214-224
• Main Authors: Nørgård, B. M., Nielsen, J., Qvist, N., Gradel, K. O., Muckadell, O. B. Schaffalitzky, Kjeldsen, J.
• Format: Article
• Language: English
• Subjects: Adalimumab; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Biological and medical sciences; Certolizumab Pegol; Cohort Studies; Crohn Disease - drug therapy; Crohn Disease - surgery; Denmark; Digestive system; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Immunoglobulin Fab Fragments - therapeutic use; Infliximab; Logistic Models; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Polyethylene Glycols - therapeutic use; Postoperative Complications; Preoperative Care; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12159

Summary Background A possible negative role of pre‐operative use of antitumour necrosis factor‐alpha (anti‐TNF‐α) agents on post‐operative outcomes in Crohn's disease (CD) patients is still debated. Aim To examine the impact of pre‐operative anti‐TNF‐α agents on post‐operative outcomes 30 and 60 days after CD surgery in a nationwide Danish cohort. Outcomes were death, reoperation, anastomosis leakage, intra‐abdominal abscess and bacteraemia. Methods We identified all patients having surgical procedures from 1 January 2000 to 31 December 2010 (n = 2293). Patients were classified according to use of anti‐TNF‐α agents within 12 weeks before surgery (exposed) or not (unexposed). Outcomes were obtained from nationwide registries and a bacteraemia registry. Sub‐analyses were performed for bacteraemia and for impact of pre‐operative timing of anti‐TNF‐α agents. Results Among surgical procedures for CD, 214 were exposed and 2079 were not. We found no increased relative risks of death or abscess drainage 30 or 60 days after follow‐up. Among exposed, 7.5% had a reoperation within 30 days vs. 8.6% among unexposed, adjusted odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.52–1.63. Among exposed, 3.8% had an anastomosis leakage within 30 days after surgery vs. 2.8% among unexposed, adjusted OR = 1.33, 95% CI: 0.59–3.02. No further cases of anastomosis leakages appeared within 60 days. Sub‐analyses indicated no increased risk of bacteraemia after 30 days and no increased risks when anti‐TNF‐α agents were given ≤14 days before surgery. Conclusion We found no significantly increased relative risks of post‐operative complications after use of anti‐TNF‐α agents either 12 weeks or ≤14 days before surgery for Crohn's disease.