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Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study

Authors :
Jeong Yeon Kim
Karen Zaghiyan
Amy Lightner
Phillip Fleshner
Source :
BMC Surgery, Vol 20, Iss 1, Pp 1-8 (2020)
Publication Year :
2020
Publisher :
BMC, 2020.

Abstract

Abstract Background Although biologic agents have revolutionized the medical management of severe ulcerative colitis (UC), there is considerable controversy regarding adverse effects of vedolizumab on surgical outcomes. We evaluated 30-day postoperative morbidity in UC patients undergoing abdominal colectomy (AC) treated with vedolizumab before surgery. Methods From 2007 to 2017, 285 patients were enrolled in prospectively maintained database evaluating the role of clinical, serologic markers with clinical phenotypes in UC. The patients treated with vedolizumab within 12 weeks of AC was queried, then matched 1:3:3 into 3 preoperative treatment groups based on age, gender and surgical treatment of UC; ileal pouch-anal anastomosis (IPAA) with ileostomy vs total colectomy with end stoma: a) vedolizumab (n = 25); b) anti-tumor necrosis factor (anti-TNF) (n = 74); and c) no biologics (n = 54). Thirty-day postoperative complications among patient groups were compared. Results The 3 patient groups were well-matched in other characteristics including disease duration, disease extent, medication history and preoperative serological data. There were no significant differences in the overall incidence of postoperative complications among patients treated preoperatively with vedolizumab, anti-TNFs, or no biologics (44% vs. 45% vs. 37%; p = 0.67). Although there was no significant difference between patient cohorts in infectious complications (p = 0.20), postoperative ileus (POI) was significantly more common among the vedolizumab group (n = 9; 36%) compared to anti-TNF (n = 12; 16%) or no biologics (n = 5; 9%) (p = 0.01). Multivariable analysis showed that vedolizumab treatment prior to surgery was an independent risk factor for POI (OR: 5.16, 95% CI; 1.71–15.52; p = .004). Conclusion Although preoperative vedolizumab exposure did not influence the rate of overall 30-day postoperative complications, vedolizumab tends to increase incidence of POI.

Details

Language :
English
ISSN :
14712482
Volume :
20
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Surgery
Publication Type :
Academic Journal
Accession number :
edsdoj.331d240c557b4f7ba3e12657dbf73867
Document Type :
article
Full Text :
https://doi.org/10.1186/s12893-020-00698-8