Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn's disease patients

Am J Gastroenterol. 2013 Apr;108(4):583-93. doi: 10.1038/ajg.2012.464. Epub 2013 Mar 12.


Objectives: Anti-tumor necrosis factor (anti-TNF) therapy effects on postoperative complications in Crohn's disease (CD) patients are unclear. We examined a retrospective cohort to clarify this relationship.

Methods: CD patients followed at a referral center between July 2004 and May 2011 who underwent abdominal surgery were identified. Postoperative complications (major infection, intra-abdominal abscess, peritonitis, anastomotic leak, wound infection, dehiscence, fistula, thrombotic, and death) were compared in patients exposed and unexposed to anti-TNF ≤8 weeks preoperatively. Demographics, surgical history, comorbidities, corticosteroid (CS) and immunomodulator use, Montreal classification, operative details, and preoperative nutritional status were assessed. Multivariate analysis measured the independent effect of preoperative anti-TNF on postoperative complications.

Results: Overall, 325 abdominal surgeries were performed; 150 (46%) with anti-TNF ≤8 weeks before surgery. The anti-TNF group developed overall infectious (36% vs. 25%, P=0.05) and a trend toward surgical site complications (36% vs. 25%, P=0.10) more frequently. Major postoperative and intra-abdominal septic complications did not differ between groups. Multivariable analysis showed that preoperative anti-TNF was an independent predictor of overall infectious (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.18-5.03) and surgical site (OR 1.96; 95% CI 1.02-3.77) complications.

Conclusions: In a tertiary referral center, use of anti-TNF therapy in CD patients ≤8 weeks before intestinal resection or any intra-abdominal surgery was independently associated with increases in infectious and surgical complications.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery
  • Adalimumab
  • Adult
  • Anastomotic Leak
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Certolizumab Pegol
  • Cohort Studies
  • Crohn Disease / surgery*
  • Female
  • Humans
  • Immunoglobulin Fab Fragments / adverse effects
  • Immunosuppressive Agents / adverse effects*
  • Infliximab
  • Intraabdominal Infections / etiology*
  • Male
  • Middle Aged
  • Odds Ratio
  • Polyethylene Glycols / adverse effects
  • Postoperative Complications*
  • Retrospective Studies
  • Sepsis / chemically induced
  • Surgical Wound Infection / etiology*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin Fab Fragments
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Polyethylene Glycols
  • Infliximab
  • Adalimumab
  • Certolizumab Pegol