Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with Crohn's disease – a nationwide cohort study

Authors

  • B. M. Nørgård,

    Corresponding author
    • Centre for National Clinical Databases, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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  • J. Nielsen,

    1. Centre for National Clinical Databases, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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  • N. Qvist,

    1. Department of surgical gastroenterology A, Odense University Hospital, and Research Unit of Surgical Gastroenterology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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  • K. O. Gradel,

    1. Centre for National Clinical Databases, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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  • O. B. Schaffalitzky de Muckadell,

    1. Department of medical gastroenterology S, Odense University Hospital, and Research Unit of Medical Gastroenterology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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  • J. Kjeldsen

    1. Department of medical gastroenterology S, Odense University Hospital, and Research Unit of Medical Gastroenterology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Correspondence to:

Dr B. M. Nørgård, Centre for National Clinical Databases, South, Odense University Hospital. Sdr. Boulevard 29, entrance 1014th, DK-5000 Odense C, Denmark.

E-mail: bente.noergaard@ouh.regionsyddanmark.dk

Summary

Background

A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-α) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated.

Aim

To examine the impact of pre-operative anti-TNF-α agents on post-operative outcomes 30 and 60 days after CD surgery in a nationwide Danish cohort. Outcomes were death, reoperation, anastomosis leakage, intra-abdominal abscess and bacteraemia.

Methods

We identified all patients having surgical procedures from 1 January 2000 to 31 December 2010 (n = 2293). Patients were classified according to use of anti-TNF-α agents within 12 weeks before surgery (exposed) or not (unexposed). Outcomes were obtained from nationwide registries and a bacteraemia registry. Sub-analyses were performed for bacteraemia and for impact of pre-operative timing of anti-TNF-α agents.

Results

Among surgical procedures for CD, 214 were exposed and 2079 were not. We found no increased relative risks of death or abscess drainage 30 or 60 days after follow-up. Among exposed, 7.5% had a reoperation within 30 days vs. 8.6% among unexposed, adjusted odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.52–1.63. Among exposed, 3.8% had an anastomosis leakage within 30 days after surgery vs. 2.8% among unexposed, adjusted OR = 1.33, 95% CI: 0.59–3.02. No further cases of anastomosis leakages appeared within 60 days. Sub-analyses indicated no increased risk of bacteraemia after 30 days and no increased risks when anti-TNF-α agents were given ≤14 days before surgery.

Conclusion

We found no significantly increased relative risks of post-operative complications after use of anti-TNF-α agents either 12 weeks or ≤14 days before surgery for Crohn's disease.

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