Anti-TNFs linked with more complications post-IPAA in UC

Apr 10, 2018 - E-Mentoring in IBD | Volume 11 • 2018

Issue 07

Clinical Question

For patients undergoing surgery for ulcerative colitis (UC), does anti-TNF therapy affect post-operative health outcomes?

Editor’s Bottom Line

Physicians and surgeons counselling patients with UC should be aware that preoperative anti-TNF therapy predicts worse outcomes after ileal pouch-anal anastomosis (IPAA).

Reference

Kulaylat AS, Kulaylat AN, Schaefer EW, et al. Association of preoperative anti-tumor necrosis factor therapy adverse postoperative outcomes in patients undergoing abdominal surgery for ulcerative colitis. JAMA Surg. 2017 Aug 16;152(8):e171538. https://www.ncbi.nlm.nih.gov/pubmed/28614561

Synopsis

Patients undergoing abdominal surgery for UC (subtotal colectomy or total abdominal colectomy (SC/TAC), total proctocolectomy with end ileostomy (TPEI), or IPAA) were identified from the MarketScan Commercial Claims and Encounters (CCAE) database (Truven Health Analytics), comprised of individuals and their dependents with employer-based healthcare insurance. Comorbidities and medication use within 90 days of surgery were recorded. Primary study outcomes in the post-operative period included complications, emergency department visits, and readmissions within 90 days of discharge for index surgery.

The study cohort was comprised of 2476 patients with UC of which 950 (38.4%) underwent SC/TAC, 354 (14.3%) had TPEI, and 1172 (47.3%) received IPAA. In each cohort, anti-TNF use was significantly associated with younger age. Preoperative use of anti-TNFs was not associated with post-operative complications for patients undergoing SC/TAC. For TPEI, anti-TNF use was associated with 83% higher odds for readmission (1.83, 95% CI: 1.08-3.10, P=0.02) in multivariate analyses. For IPAA, anti-TNF use increased odds of post-operative complications by 38% (1.38, 95% CI:1.05-1.82, P=0.02). Relative to IPAA patients without anti-TNF, those receiving anti-TNF had more complications involving lysis of adhesions (P=0.005) and wound debridement and dehiscence (P=0.06). In general, females undergoing IPAA also had ~30% higher odds of overall complications, emergency department visits, and readmission (P≤0.03 for each).

Details

Study Design: Retrospective cohort study
Funding: Carlino Fund for IBD Research at Penn State Health Milton S. Hershey Medical Center
Allocation: n/a
Setting: CCAE database, United States
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.