Alhassan Noura, Alnwdel Abdullah Nasser, Beyari Mohammed Basem, Aldeligan Saleh Husam, Alhassan Reem, Abdulla Maha Hamadien, Bin Traiki Thamer
Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Colorectal Surgery, Department of Surgery, King Fahad Specialist Hospital, Buraydah, Saudi Arabia.
Ther Clin Risk Manag. 2025 Jul 22;21:1149-1159. doi: 10.2147/TCRM.S527037. eCollection 2025.
Biologics, particularly anti-TNF agents, have transformed the management of inflammatory bowel disease (IBD), but concerns about their perioperative safety persist.
This study evaluates the knowledge, attitudes, and practices of surgeons in Saudi Arabia regarding the preoperative management of IBD patients undergoing surgery while on biological treatments.
A cross-sectional survey was conducted among 115 surgeons. Participants included general and colorectal surgeons with extensive experience in IBD management. Data were analyzed to assess knowledge, attitudes, and practices related to the impact of biologics, corticosteroids, and immunomodulators on wound healing and postoperative complications.
The response rate of 67.8% and Most surgeons (74.4%) believed biologics negatively affect wound healing, despite evidence suggesting their safety. Corticosteroids were unanimously recognized for their adverse effects, while immunomodulators were widely perceived as safe. A majority preferred tapering biologics and corticosteroids 4 weeks preoperatively but continued immunomodulators. Differences between specialties were observed, with colorectal surgeons demonstrating greater adherence to evidence-based guidelines compared to general surgeons, who expressed more concerns about biologics' risks.
This study identifies a persistent gap between evidence and practice in the perioperative management of IBD patients on biologics among Saudi surgeons, with general surgeons often stopping biologics due to safety concerns despite evidence of their safety, while colorectal surgeons are more likely to follow current guidelines. Unnecessary cessation may increase disease flare risk, highlighting the need for targeted education and multidisciplinary collaboration to optimize surgical outcomes.
生物制剂，尤其是抗 TNF 药物，已经改变了炎症性肠病（IBD）的治疗方式，但对其围手术期安全性的担忧依然存在。
本研究评估沙特阿拉伯外科医生对于接受生物治疗的 IBD 患者术前管理的知识、态度和实践。
对 115 名外科医生进行了横断面调查。参与者包括在 IBD 管理方面有丰富经验的普通外科医生和结直肠外科医生。分析数据以评估与生物制剂、皮质类固醇和免疫调节剂对伤口愈合及术后并发症影响相关的知识、态度和实践。
回复率为 67.8%，大多数外科医生（74.4%）认为生物制剂会对伤口愈合产生负面影响，尽管有证据表明其安全性。皮质类固醇因其不良反应而被一致认可，而免疫调节剂被广泛认为是安全的。大多数人倾向于在术前 4 周逐渐减少生物制剂和皮质类固醇的用量，但继续使用免疫调节剂。观察到不同专业之间存在差异，与普通外科医生相比，结直肠外科医生对循证指南的遵循度更高，普通外科医生对生物制剂的风险更为担忧。
本研究发现沙特外科医生在对接受生物制剂治疗的 IBD 患者进行围手术期管理时，证据与实践之间存在持续差距，普通外科医生常常因安全担忧而停用生物制剂，尽管有证据表明其安全性，而结直肠外科医生更有可能遵循现行指南。不必要的停药可能会增加疾病复发风险，凸显了进行针对性教育和多学科协作以优化手术结果的必要性。
