Postoperative outcomes in vedolizumab‐treated Crohn's disease patients undergoing major abdominal operations
Summary Background Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post‐operative complications. Aim We so...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2018-03, Vol.47 (5), p.573-580 |
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| creator | Lightner, A. L. McKenna, N. P. Tse, C. S. Raffals, L. E. Loftus, E. V. Mathis, K. L. |
| description | Summary
Background
Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post‐operative complications.
Aim
We sought to compare 30‐day postoperative infectious complication rate among vedolizumab‐treated Crohn's disease patients vs those who had received TNFα inhibitors or no biologic therapy.
Methods
A retrospective review of all Crohn's disease patients who received vedolizumab within 12 weeks of a major abdominal or pelvic operation was performed. Two control cohorts consisted of Crohn's disease patients treated with TNFα inhibitors or no biologic therapy.
Results
One hundred Crohn's disease patients received vedolizumab within 12 weeks of an abdominal operation. Vedolizumab‐treated patients underwent an equivalent rate of laparoscopic surgery (P = .25), had fewer anastomoses performed (P = .0002), and had equally frequent diversion in the setting of anastomoses (P = .47). Thirty‐two vedolizumab‐treated patients experienced postoperative infectious complications (32%), 26 of which were surgical site infections (26%). The vedolizumab‐treated group experienced no difference in nonsurgical site infections (6% vs 5% anti‐TNFα and 2% nonbiologic; P = .34), but significantly higher rates of surgical site infections (26% vs 8% and 11%; P |
| doi_str_mv | 10.1111/apt.14459 |
| format | Article |
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Background
Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post‐operative complications.
Aim
We sought to compare 30‐day postoperative infectious complication rate among vedolizumab‐treated Crohn's disease patients vs those who had received TNFα inhibitors or no biologic therapy.
Methods
A retrospective review of all Crohn's disease patients who received vedolizumab within 12 weeks of a major abdominal or pelvic operation was performed. Two control cohorts consisted of Crohn's disease patients treated with TNFα inhibitors or no biologic therapy.
Results
One hundred Crohn's disease patients received vedolizumab within 12 weeks of an abdominal operation. Vedolizumab‐treated patients underwent an equivalent rate of laparoscopic surgery (P = .25), had fewer anastomoses performed (P = .0002), and had equally frequent diversion in the setting of anastomoses (P = .47). Thirty‐two vedolizumab‐treated patients experienced postoperative infectious complications (32%), 26 of which were surgical site infections (26%). The vedolizumab‐treated group experienced no difference in nonsurgical site infections (6% vs 5% anti‐TNFα and 2% nonbiologic; P = .34), but significantly higher rates of surgical site infections (26% vs 8% and 11%; P < .001). On univariate and multivariate analysis, exposure to vedolizumab remained a significant predictor of postoperative surgical site infection (P < .001 and P = .002).
Conclusions
Twenty‐six per cent of Crohn's disease patients who received vedolizumab within 12 weeks prior to a major abdominal operation experienced a 30‐day postoperative surgical site infection, significantly higher than that of patients receiving TNFα inhibitors or no biologic therapy. Vedolizumab within 12 weeks of surgery remained a predictor of 30‐day postoperative surgical site infection on multivariable analysis. While vedolizumab‐treated Crohn's disease patients may be a sicker cohort of patients, it is important to consider these findings with regard to preoperative counselling, operative timing and primary closure of wounds.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.14459</identifier><identifier>PMID: 29250800</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Abdomen ; Abdomen - surgery ; Adolescent ; Adult ; Aged ; Antibodies, Monoclonal, Humanized - therapeutic use ; Cohort Studies ; Complications ; Crohn Disease - drug therapy ; Crohn Disease - epidemiology ; Crohn Disease - surgery ; Crohn's disease ; Female ; Humans ; Infections ; Inhibitors ; Laparoscopy ; Male ; Medical treatment ; Middle Aged ; Multivariate analysis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Period ; Retrospective Studies ; Surgery ; Surgical site infections ; Surgical Wound Infection - epidemiology ; Surgical Wound Infection - etiology ; Treatment Outcome ; Wounds ; Young Adult</subject><ispartof>Alimentary pharmacology & therapeutics, 2018-03, Vol.47 (5), p.573-580</ispartof><rights>2017 John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons Ltd.</rights><rights>Copyright © 2018 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-91c28aadbce2279fcfcb69d2982121d0fca4dbe536bc08d78192e52b8f2f1ddf3</citedby><cites>FETCH-LOGICAL-c3889-91c28aadbce2279fcfcb69d2982121d0fca4dbe536bc08d78192e52b8f2f1ddf3</cites><orcidid>0000-0002-0459-0699</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.14459$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.14459$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29250800$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lightner, A. L.</creatorcontrib><creatorcontrib>McKenna, N. P.</creatorcontrib><creatorcontrib>Tse, C. S.</creatorcontrib><creatorcontrib>Raffals, L. E.</creatorcontrib><creatorcontrib>Loftus, E. V.</creatorcontrib><creatorcontrib>Mathis, K. L.</creatorcontrib><title>Postoperative outcomes in vedolizumab‐treated Crohn's disease patients undergoing major abdominal operations</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post‐operative complications.
Aim
We sought to compare 30‐day postoperative infectious complication rate among vedolizumab‐treated Crohn's disease patients vs those who had received TNFα inhibitors or no biologic therapy.
Methods
A retrospective review of all Crohn's disease patients who received vedolizumab within 12 weeks of a major abdominal or pelvic operation was performed. Two control cohorts consisted of Crohn's disease patients treated with TNFα inhibitors or no biologic therapy.
Results
One hundred Crohn's disease patients received vedolizumab within 12 weeks of an abdominal operation. Vedolizumab‐treated patients underwent an equivalent rate of laparoscopic surgery (P = .25), had fewer anastomoses performed (P = .0002), and had equally frequent diversion in the setting of anastomoses (P = .47). Thirty‐two vedolizumab‐treated patients experienced postoperative infectious complications (32%), 26 of which were surgical site infections (26%). The vedolizumab‐treated group experienced no difference in nonsurgical site infections (6% vs 5% anti‐TNFα and 2% nonbiologic; P = .34), but significantly higher rates of surgical site infections (26% vs 8% and 11%; P < .001). On univariate and multivariate analysis, exposure to vedolizumab remained a significant predictor of postoperative surgical site infection (P < .001 and P = .002).
Conclusions
Twenty‐six per cent of Crohn's disease patients who received vedolizumab within 12 weeks prior to a major abdominal operation experienced a 30‐day postoperative surgical site infection, significantly higher than that of patients receiving TNFα inhibitors or no biologic therapy. Vedolizumab within 12 weeks of surgery remained a predictor of 30‐day postoperative surgical site infection on multivariable analysis. While vedolizumab‐treated Crohn's disease patients may be a sicker cohort of patients, it is important to consider these findings with regard to preoperative counselling, operative timing and primary closure of wounds.</description><subject>Abdomen</subject><subject>Abdomen - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Cohort Studies</subject><subject>Complications</subject><subject>Crohn Disease - drug therapy</subject><subject>Crohn Disease - epidemiology</subject><subject>Crohn Disease - surgery</subject><subject>Crohn's disease</subject><subject>Female</subject><subject>Humans</subject><subject>Infections</subject><subject>Inhibitors</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Period</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical site infections</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Surgical Wound Infection - etiology</subject><subject>Treatment Outcome</subject><subject>Wounds</subject><subject>Young Adult</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10btOwzAUBmALgWi5DLwAssQADKG20yT2iCpuUiU6lDly7JPiKrGDnRTBxCPwjDwJgRYGJLyc5Tu_jvwjdETJBe3fSDbtBR2PE7GFhjROk4iRON1GQ8JSETFO4wHaC2FJCEkzwnbRgAmWEE7IENmZC61rwMvWrAC7rlWuhoCNxSvQrjKvXS2Lj7f31oNsQeOJd4_2NGBtAsgAuOkXwbYBd1aDXzhjF7iWS-exLLSrjZUV3uQ7Gw7QTimrAIebuY8erq_mk9toen9zN7mcRirmXESCKsal1IUCxjJRqlIVqdBMcEYZ1aRUcqwLSOK0UITrjFPBIGEFL1lJtS7jfXS2zm28e-ogtHltgoKqkhZcF3IqMh5TniWspyd_6NJ1vj_7SwlBKE-I6NX5WinvQvBQ5o03tfQvOSX5Vwl5X0L-XUJvjzeJXVGD_pU_v96D0Ro8mwpe_k_KL2fzdeQnk1iUhw</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Lightner, A. L.</creator><creator>McKenna, N. P.</creator><creator>Tse, C. S.</creator><creator>Raffals, L. E.</creator><creator>Loftus, E. V.</creator><creator>Mathis, K. L.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0459-0699</orcidid></search><sort><creationdate>201803</creationdate><title>Postoperative outcomes in vedolizumab‐treated Crohn's disease patients undergoing major abdominal operations</title><author>Lightner, A. L. ; McKenna, N. P. ; Tse, C. S. ; Raffals, L. E. ; Loftus, E. V. ; Mathis, K. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-91c28aadbce2279fcfcb69d2982121d0fca4dbe536bc08d78192e52b8f2f1ddf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdomen</topic><topic>Abdomen - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Cohort Studies</topic><topic>Complications</topic><topic>Crohn Disease - drug therapy</topic><topic>Crohn Disease - epidemiology</topic><topic>Crohn Disease - surgery</topic><topic>Crohn's disease</topic><topic>Female</topic><topic>Humans</topic><topic>Infections</topic><topic>Inhibitors</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Period</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical site infections</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Surgical Wound Infection - etiology</topic><topic>Treatment Outcome</topic><topic>Wounds</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lightner, A. L.</creatorcontrib><creatorcontrib>McKenna, N. P.</creatorcontrib><creatorcontrib>Tse, C. S.</creatorcontrib><creatorcontrib>Raffals, L. E.</creatorcontrib><creatorcontrib>Loftus, E. V.</creatorcontrib><creatorcontrib>Mathis, K. L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lightner, A. L.</au><au>McKenna, N. P.</au><au>Tse, C. S.</au><au>Raffals, L. E.</au><au>Loftus, E. V.</au><au>Mathis, K. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative outcomes in vedolizumab‐treated Crohn's disease patients undergoing major abdominal operations</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2018-03</date><risdate>2018</risdate><volume>47</volume><issue>5</issue><spage>573</spage><epage>580</epage><pages>573-580</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Up to 80% of patients with Crohn's disease require an abdominal operation in their lifetime. As the use of vedolizumab is increasing for the treatment of Crohn's disease, it is important to understand its potential association with post‐operative complications.
Aim
We sought to compare 30‐day postoperative infectious complication rate among vedolizumab‐treated Crohn's disease patients vs those who had received TNFα inhibitors or no biologic therapy.
Methods
A retrospective review of all Crohn's disease patients who received vedolizumab within 12 weeks of a major abdominal or pelvic operation was performed. Two control cohorts consisted of Crohn's disease patients treated with TNFα inhibitors or no biologic therapy.
Results
One hundred Crohn's disease patients received vedolizumab within 12 weeks of an abdominal operation. Vedolizumab‐treated patients underwent an equivalent rate of laparoscopic surgery (P = .25), had fewer anastomoses performed (P = .0002), and had equally frequent diversion in the setting of anastomoses (P = .47). Thirty‐two vedolizumab‐treated patients experienced postoperative infectious complications (32%), 26 of which were surgical site infections (26%). The vedolizumab‐treated group experienced no difference in nonsurgical site infections (6% vs 5% anti‐TNFα and 2% nonbiologic; P = .34), but significantly higher rates of surgical site infections (26% vs 8% and 11%; P < .001). On univariate and multivariate analysis, exposure to vedolizumab remained a significant predictor of postoperative surgical site infection (P < .001 and P = .002).
Conclusions
Twenty‐six per cent of Crohn's disease patients who received vedolizumab within 12 weeks prior to a major abdominal operation experienced a 30‐day postoperative surgical site infection, significantly higher than that of patients receiving TNFα inhibitors or no biologic therapy. Vedolizumab within 12 weeks of surgery remained a predictor of 30‐day postoperative surgical site infection on multivariable analysis. While vedolizumab‐treated Crohn's disease patients may be a sicker cohort of patients, it is important to consider these findings with regard to preoperative counselling, operative timing and primary closure of wounds.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29250800</pmid><doi>10.1111/apt.14459</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0459-0699</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Free Content; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals |
| subjects | Abdomen Abdomen - surgery Adolescent Adult Aged Antibodies, Monoclonal, Humanized - therapeutic use Cohort Studies Complications Crohn Disease - drug therapy Crohn Disease - epidemiology Crohn Disease - surgery Crohn's disease Female Humans Infections Inhibitors Laparoscopy Male Medical treatment Middle Aged Multivariate analysis Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Period Retrospective Studies Surgery Surgical site infections Surgical Wound Infection - epidemiology Surgical Wound Infection - etiology Treatment Outcome Wounds Young Adult |
| title | Postoperative outcomes in vedolizumab‐treated Crohn's disease patients undergoing major abdominal operations |
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