Risk of post-operative surgical site infections after vedolizumab vs anti-tumour necrosis factor therapy: a propensity score matching analysis in inflammatory bowel disease

Autor: Berkeley N. Limketkai, Jessie J. Wong, Lindsay A. Sceats, Melody Dehghan, Cindy Kin, Anava A. Wren, Rachel Bensen, Amber W. Trickey, Kian Keyashian, K.T. Park
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Anti-Inflammatory Agents
Antibodies
Monoclonal
Humanized
Inflammatory bowel disease
Article
Vedolizumab
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Surgical Wound Infection
Pharmacology (medical)
Longitudinal Studies
Postoperative Period
Risk factor
Propensity Score
Digestive System Surgical Procedures
Retrospective Studies
Hepatology
Tumor Necrosis Factor-alpha
business.industry
Gastroenterology
Retrospective cohort study
Perioperative
Bowel resection
Inflammatory Bowel Diseases
medicine.disease
Combined Modality Therapy
030220 oncology & carcinogenesis
Propensity score matching
Female
030211 gastroenterology & hepatology
Immunotherapy
business
Abdominal surgery
medicine.drug
Zdroj: Alimentary Pharmacology & Therapeutics. 48:340-346
ISSN: 0269-2813
DOI: 10.1111/apt.14842
Popis: Background Perioperative vedolizumab (VDZ) and anti-tumour necrosis factor (TNFi) therapies are implicated in causing post-operative complications in inflammatory bowel disease (IBD). Aim To compare the risk of surgical site infections (SSIs) between VDZ- and TNFi-treated IBD patients in propensity-matched cohorts. Methods The Optum Research Database was used to identify IBD patients who received VDZ or TNFi within 30 days prior to abdominal surgery between January 2015 and December 2016. The date of IBD-related abdominal surgery was defined as the index date. SSIs were determined by ICD-9/10 and CPT codes related to superficial wound infections or deep organ space infections after surgery. Propensity score 1:1 matching established comparable cohorts based on VDZ or TNFi exposure before surgery based on evidence-based risk modifiers. Results The propensity-matched sample included 186 patients who received pre-operative biologic therapy (VDZ, n = 94; TNFi, n = 92). VDZ and TNFi cohorts were similar based on age, gender, IBD type, concomitant immunomodulator exposure, chronic opioid or corticosteroid therapy, Charlson Comorbidity Index and malnutrition. VDZ patients were more likely to undergo an open bowel resection with ostomy. After propensity score matching, there was no significant difference in post-operative SSIs (TNFi 12.0% vs VDZ 14.9%, P = 0.56). Multivariable analysis indicated that malnutrition was the sole risk factor for developing SSI (OR 3.1, 95% CI 1.11-8.71) regardless of the type of biologic exposure. Conclusion In the largest, risk-adjusted cohort analysis to date, perioperative exposure to VDZ therapy was not associated with a significantly higher risk of developing an SSI compared to TNFi therapy.
Databáze: OpenAIRE
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