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

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-alpha) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. AIM: To examine the impact of pre-operative anti-TNF-alpha 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-alpha 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-alpha 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-alpha agents were given
Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
Volume37
Issue number2
Pages (from-to)214-224
Number of pages11
ISSN0269-2813
DOIs
Publication statusPublished - 2013

Fingerprint

Crohn Disease
Cohort Studies
Reoperation
Registries
Odds Ratio
Confidence Intervals
Ambulatory Surgical Procedures

Keywords

  • Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents/therapeutic use Antibodies, Monoclonal/therapeutic use *Antibodies, Monoclonal, Humanized/therapeutic use Cohort Studies Crohn Disease/drug therapy/*surgery Denmark Female Humans Immunoglobulin Fab Fragments/therapeutic use Logistic Models Male Middle Aged Polyethylene Glycols/therapeutic use *Postoperative Complications Preoperative Care Risk Factors Time Factors Tumor Necrosis Factor-alpha/*antagonists & inhibitors Young Adult

Cite this

@article{e9ab32030e3540159be1480b87fa260f,
title = "Pre-operative use of anti-TNF-alpha agents and the risk of post-operative complications in patients with Crohn's disease--a nationwide cohort study",
abstract = "BACKGROUND: A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-alpha) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. AIM: To examine the impact of pre-operative anti-TNF-alpha 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-alpha 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-alpha 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-alpha agents were given",
keywords = "Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents/therapeutic use Antibodies, Monoclonal/therapeutic use *Antibodies, Monoclonal, Humanized/therapeutic use Cohort Studies Crohn Disease/drug therapy/*surgery Denmark Female Humans Immunoglobulin Fab Fragments/therapeutic use Logistic Models Male Middle Aged Polyethylene Glycols/therapeutic use *Postoperative Complications Preoperative Care Risk Factors Time Factors Tumor Necrosis Factor-alpha/*antagonists & inhibitors Young Adult",
author = "N{\o}rg{\aa}rd, {Bente Mertz} and J. Nielsen and N. Qvist and Gradel, {K. O.} and {Schaffalitzky de Muckadell}, {Ove B.} and J. Kjeldsen",
note = "{\circledC} 2012 Blackwell Publishing Ltd.",
year = "2013",
doi = "10.1111/apt.12159",
language = "English",
volume = "37",
pages = "214--224",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Pre-operative use of anti-TNF-alpha agents and the risk of post-operative complications in patients with Crohn's disease--a nationwide cohort study

AU - Nørgård, Bente Mertz

AU - Nielsen, J.

AU - Qvist, N.

AU - Gradel, K. O.

AU - Schaffalitzky de Muckadell, Ove B.

AU - Kjeldsen, J.

N1 - © 2012 Blackwell Publishing Ltd.

PY - 2013

Y1 - 2013

N2 - BACKGROUND: A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-alpha) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. AIM: To examine the impact of pre-operative anti-TNF-alpha 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-alpha 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-alpha 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-alpha agents were given

AB - BACKGROUND: A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-alpha) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. AIM: To examine the impact of pre-operative anti-TNF-alpha 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-alpha 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-alpha 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-alpha agents were given

KW - Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents/therapeutic use Antibodies, Monoclonal/therapeutic use Antibodies, Monoclonal, Humanized/therapeutic use Cohort Studies Crohn Disease/drug therapy/surgery Denmark Female Humans Immunoglobuli

U2 - 10.1111/apt.12159

DO - 10.1111/apt.12159

M3 - Journal article

C2 - 23190161

VL - 37

SP - 214

EP - 224

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 2

ER -