Perioperative Use of Vedolizumab is not Associated with Postoperative Infectious Complications in Patients with Ulcerative Colitis Undergoing Colectomy

被引:53
作者
Ferrante, Marc [1 ]
van Overstraeten, Anthony de Buck [2 ]
Schils, Nikkie [1 ]
Moens, Annick [1 ]
Van Assche, Gert [1 ]
Wolthuis, Albert [2 ]
Vermeire, Severine [1 ]
D'Hoore, Andre [2 ]
机构
[1] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Gastroenterol & Hepatol, Herestr 49, B-3000 Leuven, Belgium
[2] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Abdominal Surg, Leuven, Belgium
关键词
Inflammatory bowel disease; ulcerative colitis; vedolizumab; risk factors; postoperative complications; ileal pouchanal anastomosis; INFLAMMATORY-BOWEL-DISEASE; CROHNS-DISEASE; MAINTENANCE THERAPY; INDUCTION THERAPY; CLINICAL-RESPONSE; INFLIXIMAB; OUTCOMES; REMISSION; IBD;
D O I
10.1093/ecco-jcc/jjx095
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: Preoperative use of vedolizumab has been associated with increased short-term postoperative infectious complications. We assessed this risk in a single-centre cohort of patients with ulcerative colitis undergoing colectomy. Methods: Chart review was performed for all colectomies between 2006 and 2016. Short-term postoperative [non] infectious complications were evaluated within 30 days after colectomy. The comprehensive complication index was calculated based on all reported events. Results: We identified 170 eligible patients [46% female, median age 40 years]. Thirty-four patients [20%] received vedolizumab within 16 weeks, 60 [35%] received anti-tumour necrosis factor [TNF] within 8 weeks, 32 [19%] received a moderate-to-high dose of prednisone and 71 [42%] received other therapies at colectomy. Pouch construction was performed at first stage in 47 patients [28%], and less frequently in patients under vedolizumab, anti-TNF or steroids [all p < 0.01]. Sixty-two short-term infectious and 75 noninfectious complications were reported in, respectively, 49 [29%] and 64 [38%] patients. Only pouch construction at first stage of surgery was independently associated with short-term postoperative infectious (odds ratio 2.40 [95% confidence interval 1.184.90], p = 0.016), overall complications (3.11 [1.52-6.40], p = 0.002) and more severe complications (comprehensive complication index 20.9 [0.0-30.8] vs 0.0 [0.0-20.9], p = 0.001). Perioperative medical therapy [including vedolizumab] did not influence short-term outcome, either in the overall population or in the subpopulation of patients with pouch construction at a second stage. Conclusions: Perioperative use of vedolizumab was not associated with short-term postoperative [infectious] complications. However, postponing pouch construction to a second stage of surgery is advisable in patients under biological therapy or moderate-to-high doses of steroids.
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页码:1353 / 1361
页数:9
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