Pre-operative use of anti-TNF-a agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

Background It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-alpha) agents increase post-operative complications in patients with ulcerative colitis (UC). Aim In a nationwide Danish cohort of patients with UC, we aimed to examine the impact of pre-operative use of anti-TNF-alpha 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. Methods 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 200331 December 2010 (n = 1226). Patients were classified according to use of anti-TNF-alpha 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-alpha agents, relative to those not treated. Results A total of 199 UC patients were exposed to anti-TNF-alpha 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: 0.711.59) and 0.52 (95% CI: 0.064.11) 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. Conclusions Based on nationwide data on UC patients having colectomies, pre-operative use of anti-TNF-alpha agents did not increase the risk of post-operative complications.