Department of Surgery, University of Maryland School of Medicine, 29 South Greene Street, 6th Floor, Baltimore, MD, 21201, USA.
Division of Gastroenterology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Dig Dis Sci. 2019 Jul;64(7):1959-1966. doi: 10.1007/s10620-019-5476-2. Epub 2019 Jan 25.
The impact of postoperative anti-TNF therapy on infectious complications following Crohn's disease surgery remains controversial. Use of anti-TNF therapy 2-4 weeks postoperatively appears safe, but safety of use within 2 weeks is unknown.
We sought to evaluate the effect of anti-TNF therapy initiated within 2 weeks of abdominal surgery in patients with Crohn's disease.
We conducted a retrospective review of adult Crohn's disease patients undergoing abdominal surgery between 2004 and 2011. Infectious and non-infectious complications were compared between patients exposed to anti-TNF therapy within 2 weeks or between 2 and 4 weeks postoperatively and to those without exposure using chi-squared and regression analysis.
Three hundred thirty-one abdominal surgeries were included; 241 were without anti-TNF exposure, 46 received postoperative anti-TNF within 2 weeks of surgery, and 44 received anti-TNF therapy 2-4 weeks after surgery. Patients who received anti-TNF therapy within 2 weeks of surgery, those initiated between 2 and 4 weeks of surgery, and those who did not receive anti-TNF therapy within 4 weeks of surgery had no significant difference in rates of infectious complications (22%, 32%, 33%, p = 0.332). Rates of non-infectious complications (4%, 9%, 14%, p = 0.143), mortality (0%, 0%, 3%, p = 0.105), hospital readmission (17%, 16%, 15%, p = 0.940), and reoperation (11%, 11%, 16%, p = 0.563) were also similar between groups.
Use of early anti-TNF therapy within 2 weeks or between 2 and 4 weeks following abdominal surgery did not increase risk of postoperative surgical infections in Crohn's patients.
术后使用抗 TNF 治疗对克罗恩病手术后感染并发症的影响仍存在争议。术后 2-4 周使用抗 TNF 治疗似乎是安全的，但在 2 周内使用的安全性尚不清楚。
我们旨在评估克罗恩病患者在腹部手术后 2 周内开始使用抗 TNF 治疗的效果。
我们对 2004 年至 2011 年间接受腹部手术的成年克罗恩病患者进行了回顾性研究。使用卡方检验和回归分析比较了暴露于术后 2 周内或 2-4 周内抗 TNF 治疗的患者与未暴露于抗 TNF 治疗的患者之间的感染性和非感染性并发症。
共纳入 331 例腹部手术；241 例无抗 TNF 暴露，46 例术后 2 周内接受抗 TNF 治疗，44 例术后 2-4 周内接受抗 TNF 治疗。术后 2 周内接受抗 TNF 治疗的患者、2-4 周内开始治疗的患者和术后 4 周内未接受抗 TNF 治疗的患者之间，感染并发症的发生率无显著差异（22%、32%、33%，p=0.332）。非感染性并发症发生率（4%、9%、14%，p=0.143）、死亡率（0%、0%、3%，p=0.105）、住院再入院率（17%、16%、15%，p=0.940）和再次手术率（11%、11%、16%，p=0.563）也相似。
在腹部手术后 2 周内或 2-4 周内使用早期抗 TNF 治疗并未增加克罗恩病患者术后手术感染的风险。
