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

Background A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-a) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. Aim To examine the impact of pre-operative anti-TNF-a agents on post-operative outcomes 30 and 60days 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-a agents within 12weeks 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-a 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 60days after follow-up. Among exposed, 7.5% had a reoperation within 30days vs. 8.6% among unexposed, adjusted odds ratio (OR)=0.92, 95% confidence interval (CI): 0.521.63. Among exposed, 3.8% had an anastomosis leakage within 30days after surgery vs. 2.8% among unexposed, adjusted OR=1.33, 95% CI: 0.593.02. No further cases of anastomosis leakages appeared within 60days. Sub-analyses indicated no increased risk of bacteraemia after 30days and no increased risks when anti-TNF-a agents were given =14days before surgery. Conclusion We found no significantly increased relative risks of post-operative complications after use of anti-TNF-a agents either 12weeks or =14days before surgery for Crohn's disease.