More than a quarter of patients undergoing intestinal resection for CD had early, postoperative complications. High disease activity increased the risk.
Although it is widely recognized that TNF blockers are not associated with an increased risk for postoperative complications, data from patients with CD treated with newer agents like vedolizumab and ustekinumab are more limited, heterogenous, and controversial. Therefore, Mathurin Fumery, MD, of Centre Hospitalier Universitaire d’Amiens, and colleagues evaluated the impact of preoperative biological therapy with TNF-blockers, vedolizumab, and ustekinumab on the risk for postoperative complications. In addition, they aimed to identify patient- and surgery-related factors that might impact a patient’s outcome.
In their retrospective nationwide study across 23 centers in France, they assessed all consecutive patients who underwent intestinal resection for CD between July 2014 and April 2022 and assessed early postoperative complications (≤30 days) in different cohorts according to intake of TNF blockers, vedolizumab, or ustekinumab.
Data for 1,201 patients was analyzed. Strictures were the most frequent reasons for surgery (52%). “Almost all patients had active disease at surgery,” Dr. Fumery said.
In total, 26.4% of patients suffered from an early postoperative complication and 10% had at least one severe complication. Regardless of the receipt of biologics, abdominal septic complications were the most frequent complication. Factors associated with complications in the multivariate analysis were age (OR, 1.17), disease activity (OR, 8.36), abscess (OR, 2.01), and an initial stoma (OR, 1.07). In contrast, preoperative exposure to TNF blockers and the newer biologics vedolizumab and ustekinumab within 3 months before surgery was not associated with an increased risk for early postoperative complications. Conversely, preoperative enteral nutrition could be identified as a protective factor associated with a relative risk reduction of 88% for intra-abdominal infectious complications.
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