Document Detail


Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn's disease.
MedLine Citation:
PMID:  20872084     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There have been numerous studies with conflicting results regarding the use of anti-tumor necrosis factor (TNF) therapy and its relationship to postoperative outcome in Crohn disease. The aim of our study was to examine the rate of postoperative morbidity in patients receiving anti TNF therapy in the perioperative period.
METHODS: All patients undergoing surgery for Crohn disease from 2005 till 2008 were abstracted from a prospective database. Patients undergoing surgery which included a suture or staple line at risk for leaking were selected for the study. A retrospective review of medical records was performed. The study group comprised patients treated with perioperative anti TNF therapy (defined as treatment within 8 weeks preoperatively or up to 30 days postoperatively). The remainder of the patients did not receive perioperative anti TNF therapy. Patient characteristics, disease severity, medication use, operative intervention and 30-day complication were compared between the two groups.
RESULTS: Three hundred and seventy patients were selected for analysis in this study, of which 119 received perioperative anti TNF therapy and 251 did not. The groups were similar in baseline characteristics, perioperative risk factors and procedures. The group who received perioperative anti TNF therapy had a more severe disease overall as measured by the American College of Gastroenterology (ACG) categories of disease (50% severe fulminant disease in the perioperative anti-TNF therapy group versus 18% in the group that did not receive perioperative anti-TNF therapy, p < 0.001). There was no significant association of perioperative anti TNF therapy and any postoperative complications (27.9% in anti-TNF group versus 30.1% in no anti-TNF group, p = 0.63) nor intra-abdominal infectious complications (5.0% in anti-TNF group versus 7.2% in no anti-TNF group, p = 0.44). Univariate analysis showed that the only factors associated with an increase in postoperative intra-abdominal infections were age and penetrating disease.
CONCLUSIONS: The use of anti-TNF therapy in the perioperative period is safe and is not associated with an increase in overall or infectious complications in Crohn disease patients undergoing surgery.
Authors:
Basil S Nasir; Eric J Dozois; Robert R Cima; John H Pemberton; Bruce G Wolff; William J Sandborn; Edward V Loftus; David W Larson
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Publication Detail:
Type:  Journal Article     Date:  2010-09-25
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  14     ISSN:  1873-4626     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-25     Completed Date:  2011-03-30     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1859-65; discussion 1865-6     Citation Subset:  IM    
Affiliation:
Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Antibodies, Monoclonal / adverse effects
Antibodies, Monoclonal, Humanized
Crohn Disease / drug therapy,  surgery*
Female
Humans
Immunoglobulin Fab Fragments / adverse effects
Male
Middle Aged
Polyethylene Glycols / adverse effects
Postoperative Complications / chemically induced*,  epidemiology*
Retrospective Studies
Time Factors
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Young Adult
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Immunoglobulin Fab Fragments; 0/Polyethylene Glycols; 0/Tumor Necrosis Factor-alpha; 0/infliximab; FYS6T7F842/adalimumab; UMD07X179E/certolizumab pegol
Comments/Corrections
Comment In:
Inflamm Bowel Dis. 2012 Aug;18(8):1588   [PMID:  22238178 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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