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Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Postoperative outcomes in vedolizumab-treated pediatric patients undergoing abdominal operations for inflammatory
Amy L Lightner1, Chung Sang Tse2, D Dean Potter3
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Vedolizumab is safe for pediatric inflammatory bowel disease (IBD) patients undergoing surgery. No 30-day postoperative infectious complications were observed in pediatric IBD patients receiving vedolizumab perioperatively.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Immunology
Background:
- Vedolizumab use is linked to increased postoperative complications in adult IBD patients.
- Data on vedolizumab's perioperative safety in pediatric IBD surgery is limited.
- This study addresses the gap in understanding vedolizumab's safety in pediatric surgical IBD patients.
Purpose of the Study:
- To determine the 30-day postoperative infectious complication rate in pediatric IBD patients receiving vedolizumab.
- To compare outcomes between pediatric IBD patients treated with vedolizumab and anti-TNF therapy before surgery.
Main Methods:
- Retrospective comparative study of pediatric IBD patients undergoing abdominal operations.
- Cohort 1: Patients receiving vedolizumab within 12 weeks of surgery.
- Cohort 2: Patients receiving anti-TNF therapy within 12 weeks of surgery.
Main Results:
- No significant differences in demographics or preoperative factors between vedolizumab and anti-TNF groups.
- Higher prior biologic exposure in the vedolizumab group (p<0.0001).
- No significant differences in 30-day postoperative complications (infections, SBO/ileus, readmission, ROR) between groups.
Conclusions:
- No 30-day postoperative SSIs or infectious complications occurred in pediatric IBD patients receiving vedolizumab.
- Vedolizumab appears safe in the perioperative period for pediatric IBD surgery.
- Multi-institutional studies are needed to confirm these findings due to the small sample size.
Introduction:
Recent studies have found vedolizumab to be an independent predictor of increased rates of postoperative complications and surgical site infections (SSIs) in adults with inflammatory bowel disease (IBD), but studies in the pediatric surgical population are lacking. We sought to determine the 30-day postoperative infectious complication rate among pediatric IBD patients who received vedolizumab within 12weeks of a major abdominal operation.
Methods:
A retrospective chart review was performed on pediatric IBD patients who underwent an abdominal operation between 5/20/2014 and 6/1/2017. The study cohort was comprised of pediatric patients (≤18years) who received vedolizumab within 12weeks prior to their abdominal operation. The control cohort was all patients operated on for IBD during the same time on anti-TNF therapy within 12weeks of their abdominal operation.
Results:
Thirteen pediatric patients (5 female) received vedolizumab within 12weeks of an abdominal operation and 36 patients received anti TNF therapy (20 female). There were no differences in the vedolizumab and anti-TNF therapy with regard to sex, median age of diagnosis or operation, IBD type, body mass index (BMI), smoking status, diabetes mellitus (DM), preoperative serum laboratory values, steroid or immunomodulatory use. The number of biologics previously exposed to was significantly higher in the vedolizumab treated patients (p<0.0001). There were no significant differences in operative characteristics including laparoscopic versus open surgery, construction of an anastomosis, or diversion of an anastomosis. There were also no significant differences found in 30-day postoperative complications including nonsurgical site infections (SSIs), all SSIs, small bowel obstruction (SBO)/ileus, hospital readmission, or return to the operating room (ROR). There were four RORs in total: one in the vedolizumab group was for a missed enterotomy and stoma revision; three in the anti-TNF cohort were for ileostomy revisions.
Conclusions:
None of the thirteen pediatric patients who received vedolizumab within 12weeks of an abdominal operation experienced a 30-day postoperative SSI or non SSI infectious complication, suggesting that vedolizumab is safe in the perioperative period for pediatric patients with IBD. Owing to the small sample size, future study, perhaps multi-institutional, will be important to confirm these findings.
Level Of Evidence:
Retrospective comparative study, Level III.
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