INFLAMMATORY BOWEL DISEASE
Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis – a nationwide cohort study
Article first published online: 16 APR 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 11, pages 1301–1309, June 2012
How to Cite
Nørgård, B. M., Nielsen, J., Qvist, N., Gradel, K. O., de Muckadell, O. B. S. and Kjeldsen, J. (2012), Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis – a nationwide cohort study. Alimentary Pharmacology & Therapeutics, 35: 1301–1309. doi: 10.1111/j.1365-2036.2012.05099.x
- Issue published online: 1 MAY 2012
- Article first published online: 16 APR 2012
- Manuscript Accepted: 27 MAR 2012
- Manuscript Revised: 22 MAR 2012
- Manuscript Revised: 15 MAR 2012
- Manuscript Received: 5 FEB 2012
- Danish Colitis-Crohn Society
It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC).
In a nationwide Danish cohort of patients with UC, we aimed to examine the impact of pre-operative use of anti-TNF-α agents on post-operative adverse outcomes after colectomy for UC. Outcomes (within 30 and 60 days after surgery) were reoperation, anastomosis leakage, intra-abdominal abscess, bacteremia and death.
Based on the Danish National Patient Registry we identified all UC patients, aged ≥15 years, having their first surgery for UC in the period of 1 January 2003–31 December 2010 (n = 1226). Patients were classified according to use of anti-TNF-α agents within 12 weeks before surgery or not. Outcome data were obtained from Danish registries. Logistic regression analyses were used to estimate adjusted risks [with 95% confidence intervals (CI)] of post-operative outcomes among patients treated with anti-TNF-α agents, relative to those not treated.
A total of 199 UC patients were exposed to anti-TNF-α agents within 12 weeks before colectomy, and 1027 were not. Among exposed, the adjusted odds ratio of reoperation and anastomosis leakage within 30 days after colectomy was 1.07 (95% CI: 0.71–1.59) and 0.52 (95% CI: 0.06–4.11) respectively. No deaths, cases of abscess drainage or bacteremia occurred among exposed within 30 days. Furthermore, no increased relative risks were found within 60 days after colectomy.
Based on nationwide data on UC patients having colectomies, pre-operative use of anti-TNF-α agents did not increase the risk of post-operative complications.