Pre-op biologics not tied to post-op infection in IBD

In patients undergoing surgery for inflammatory bowel disease (IBD), presurgical exposure to biologics was not associated with an increased risk of post-surgical infectious complications or surgical site infections, according to a study presented at the recent Crohn’s and Colitis Congress 2021.

The researchers obtained data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Inflammatory Bowel Disease (IBD) Collaborative and in this study, included 1,562 patients who underwent surgery for IBD at 10 IBD centres between 2017 and 2018. Of these, 47 percent (n=730) were exposed to biologics within 60 days prior to surgery.

Compared with the 832 patients not exposed to biologics, patients with presurgical biologic exposure had more presurgical weight loss, lower albumin levels, and more exposure to immunomodulators or steroids. There was a greater proportion of patients with Crohn’s disease in the biologics group, and more patients in this group experienced systemic sepsis (p<0.001 for all).

Patients with exposure to biologics were also more likely to have received a new ostomy and to have undergone colectomy compared with a proctectomy or small bowel procedure, while fewer patients had undergone elective surgery (p<0.001 for all).

Multivariate analysis showed that use of biologics prior to surgery was not associated with an increased risk of post-surgical infectious complications (odds ratio [OR], 0.88, 95 percent confidence interval [CI], 0.54–1.42; p=0.60). [Crohn’s and Colitis Congress 2021, session: Adult IBD: Quick Shots Abstracts and Case Discussions]

There was also no association between presurgical exposure to biologics and surgical site infection (OR, 0.77, 95 percent CI, 0.46–1.28; p=0.31).

Patients with Crohn’s disease had an increased risk of post-surgical infectious complications (OR, 2.13, 95 percent CI, 1.12–4.00), as did those who underwent protectomy (OR, 3.15, 95 percent CI, 1.25–7.95; p=0.02 for both).

The use of immunomodulators or steroids was not significantly tied to an increased risk of post-surgical infectious complications (OR, 1.00; p=0.99 and OR, 1.13; p=0.73, respectively), or surgical site infections (OR, 1.12; p=0.73 and OR, 1.29; p=0.40, respectively).

New ostomy construction was also not associated with an increased risk of post-surgical infectious complications (OR, 1.02; p=0.96) or surgical site infection (OR, 0.82; p=0.56), nor was undergoing emergency surgery (OR, 2.00; p=0.18 and OR, 1.30; p=0.67, respectively).

The association between presurgical biologic use and post-surgical infections has been investigated in prior studies. For instance, a meta-analysis of 12,494 patients with ulcerative colitis, 2,254 of whom had presurgical exposure to biologics, found no association between presurgical biologic use and post-surgical infection-related complications. [Ther Adv Gastroenterol 2020;13:1-12]

“[In this study comprising] the largest nationally representative retrospective cohort to date, we found that biologics exposure within 60 days of surgery for IBD, using well-validated methodology and after vigorous adjustment for disease- and surgery-specific covariates, was not associated with postoperative infectious or surgical site infectious complications,” noted the researchers.