Issue 11

Clinical Question

For patients living with inflammatory bowel disease (IBD), does pre-operative therapy with vedolizumab (VDZ) increase the risk for 30-day post-operative complications?

Editor’s Bottom Line

Pre-operative exposure to vedolizumab appears to be safe.

Reference

Yamada A, Komaki Y, Patel N, et al. Risk of postoperative complications among inflammatory bowel disease patients treated preoperatively with vedlolizumab. Am J Gastroenterol. 2017 Sep:112(9):1423–29. https://www.ncbi.nlm.nih.gov/pubmed/28719595

Synopsis

All patients receiving IBD-related medications within 4 weeks of bowel surgery between June 2014 and April 2016 were included in the study. Patients were categorized according to IBD type (UC vs. CD), medication use (VDZ, anti-TNFs, non-biologics), surgery type (major: resection; minor: exams under anaesthesia, hernia, ostomy creation, and ileostomy), and urgency (planned or emergent). All patients were followed for 30 days post-operatively with complications categorized as either infectious or non-infectious.

Of the 443 patients included in analysis (UC, 186; CD, 257), 64 individuals (UC, 24; CD, 40) had VDZ pre-operatively. There were 15 (24.3%) cases of post-operative complications. The post-operative complication rates for patients receiving anti-TNFs or non-biologics were 40 (31.0%) and 89 (35.6%), respectively and were not significantly different when compared to VDZ (P=0.16). Of note, the infectious post-operative complication rate was significantly (P=0.03) lower with VDZ (3.1%) compared to anti-TNFs (14.7%) or non-biologics (13.6%). Multivariate analyses identified two factors that increased the odds ratio for 30-day post-operative complications: age >65 years (OR, 3.56) and low albumin levels (OR 2.26).

Details

Study Design: Retrospective cohort study
Funding: None
Allocation: n/a
Setting: Single tertiary care centre, Chicago, IL
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.