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Anti-TNF biologic therapy does not increase postoperative morbidity in pediatric Crohn's patients
Amy L Lightner1, Nicholas P McKenna2, Ahmad Alsughayer1
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Preoperative anti-TNF biologic therapy in pediatric Crohn's disease patients did not increase 30-day postoperative infectious complications or other morbidities. This finding supports the safe use of these therapies before abdominal surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Immunology
Background:
- Limited data exists on the impact of preoperative biologic therapy on postoperative complications in pediatric Crohn's disease (CD) patients undergoing abdominal surgery.
- Assessing 30-day postoperative infectious complication rates is crucial for evaluating surgical risk in this population.
Purpose of the Study:
- To determine the 30-day postoperative infectious complication rate in pediatric CD patients receiving biologic therapy within 12 weeks of abdominal surgery.
- To compare complication rates between patients exposed to anti-TNF agents and those who were not.
Main Methods:
- Retrospective chart review of pediatric CD patients (<18 years) who underwent abdominal surgery between 2008 and 2017.
- Patients were categorized based on anti-tumor necrosis factor (TNF) biologic therapy (infliximab, adalimumab, certolizumab pegol) received within 12 weeks prior to surgery.
- Primary outcome: 30-day postoperative infectious complications; Secondary outcomes: readmission and return to operating room (ROR).
Main Results:
- 69 pediatric CD patients met inclusion criteria (54 received anti-TNF therapy, 15 did not).
- No significant differences in 30-day postoperative infectious complications (overall, surgical, or nonsurgical) were observed between anti-TNF exposed and unexposed groups.
- Rates of ileus, readmission, and ROR were also similar between the groups.
Conclusions:
- Preoperative exposure to anti-TNF biologic therapy does not increase 30-day postoperative morbidity in pediatric CD patients.
- The findings suggest that anti-TNF therapy can be safely administered prior to abdominal surgery in this patient group.
Introduction:
Limited knowledge exists as to what impact preoperative biologic therapy has on postoperative complications in pediatric patients undergoing abdominal surgery for Crohn's disease (CD). Therefore, we sought to determine the 30-day postoperative infectious complication rate among pediatric CD patients who received biologic therapy within 12 weeks of an abdominal operation.
Methods:
A retrospective chart review was performed on pediatric (<18 years of age) CD patients who underwent an abdominal operation between 1/1/2008 and 12/31/2017. Patients were grouped according to whether they received an anti-TNF (infliximab, adalimumab, certolizumab pegol) or no biologic therapy within 12 weeks prior to the operation. The primary outcome was the overall 30-day postoperative infectious complication rate. Secondary outcomes included 30-day readmission rate and return to the operating room (ROR).
Results:
A total of 69 pediatric CD patients met inclusion criteria (n = 54 anti-TNF therapy, n = 15 received no biologic therapy). There were no differences between the anti-TNF and no biologic cohorts with respect to demographics or CD characteristics. No significant differences in overall 30-day postoperative infectious complications existed between patients exposed to anti-TNF agents and those with no preoperative exposure, or in its subcategories of surgical infectious complications and nonsurgical infectious complications. There was also no difference in the rate of ileus, readmission, or ROR.
Conclusions:
Preoperative exposure to anti-TNF biologic therapy does not add to overall or infectious 30-day postoperative morbidity in pediatric CD patients.
Level Of Evidence:
III.
Type Of Study:
Retrospective review.