Introduction: Anti-tumor necrosis factor (TNF) alpha medications are approved for the treatment of inflammatory bowel disease (IBD). Due to concern for post-operative complications, patients are often counseled to pause anti-TNF treatment prior to surgery. However, gaps in anti-TNF treatment can lead to IBD flares and anti-drug antibody formation. No guidelines on the use of anti-TNFs in the perioperative period exist. The impact of anti-TNF use prior to bowel resection on infectious and noninfectious complication rates was analyzed in this study.
Methods: A retrospective analysis of 4928 patients in the Humana subset of the PearlDiver national database was performed. Patients with Crohn's Disease or ulcerative colitis and bowel resection after diagnosis were included. Patients were stratified into various treatment groups including anti-TNFs, corticosteroids, or neither anti-TNFs nor corticosteroids. Prescriptions filled for anti-TNFs, corticosteroids, or neither were analyzed at 3 months, 2 months, 1 month, and 2 weeks prior to bowel resection. Complication rates at postoperative day 30 were compared among all groups using a chi-square analysis with an alpha level of 0.05. Post-hoc pairwise chi-square tests were run on timepoints with significant results with a Bonferroni adjusted alpha level of 0.005.
Results: Medication use at 3 months, 2 months, and 1 month before bowel resection was significantly associated with postoperative infectious complications (p= 0.019, p= 0.040, p< 0.001). Though no significant difference between medication use and infectious complications was found two weeks prior to the procedure, the same trend was noted (p= 0.149) (Figure 1). Medication use was also associated with noninfectious complications at 2 months, 1 month, and two weeks prior to procedure (p= 0.005, p= 0.001, p= 0.005) (Figure 2). Corticosteroid use was significantly associated with higher complication rates across all timepoints, relative to patients treated with neither anti-TNFs nor corticosteroids. Continued anti-TNF therapy was not significantly associated with higher complication rates at any timepoint.
Conclusion: In this analysis, there was no association between anti-TNF therapy and increased risk of infection at any timepoint, while corticosteroids were associated with increased infectious and noninfectious complications. These data suggest that anti-TNF therapy may safely be continued prior to bowel resection.