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Biologics before surgery in IBD do not elevate infection risk

Presented by
Dr S. Holubar, Cleveland Clinic, USA
ECCO 2020
Exposure to biologics within 60 days of surgery for inflammatory bowel disease (IBD) was not associated with post-operative infection risk in a large retrospective cohort. In a univariate analysis, biologics before proctectomy were associated with an increased risk of anastomotic leak [1].

The results were presented by colorectal surgeon Dr Stefan Holubar (Cleveland Clinic, USA). “A well-validated methodology was used”, he stressed. “Also, vigorous adjustment was performed for disease- and surgery-specific covariates, most notably diagnosis, chronic steroid use, immunomodulator (IMM) use, ostomy construction, anaemia, malnutrition, operative length, and emergency surgery.” The primary endpoint was any infectious complication and the secondary endpoint was any surgical site infection. Of 1,562 included patients, 730 (47%) had been exposed to biologics before surgery. There was a higher prevalence of preoperative weight loss, lower albumin, systemic sepsis, IMM and steroid use, and of Crohn’s disease (all P<0.001) in the biologics group. In this group, patients were also more likely to receive a new ostomy and to have a colectomy, while fewer had elective surgery (all P<0.001).

Biologics were not associated with any postoperative infectious complication (OR 0.88; 95% CI 0.54–1.42) or surgical site infection (OR 0.77; 95% CI 0.46–1.28). “This is likely due to judicious use of ileostomies,” Dr Holubar stated. Crohn’s disease was associated with any infectious complications (OR 2.11; 95% CI 1.12–4.0, P=0.02). There was also a strong signal of an association between biologics and an increased rate of anastomotic leak after proctectomy (6.7% vs 1.9%, P=0.02).

    1. Holubar H, et al. ECCO-IBD 2020, OP25.

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