Preoperative Use of Methotrexate and the Risk of Early Postoperative Complications in Patients with Inflammatory Bowel Disease

Inflamm Bowel Dis. 2016 Aug;22(8):1887-95. doi: 10.1097/MIB.0000000000000780.


Background: Preoperative immunosuppressive use among patients with Crohn's disease or ulcerative colitis may lead to an increased risk of postoperative complications. There is limited information on the preoperative safety profile of methotrexate (MTX) in inflammatory bowel disease (IBD).

Methods: A retrospective study of patients who underwent abdominal surgery for IBD between 1993 and 2012 was performed and records abstracted, including preoperative use of MTX, azathioprine/6-mercaptopurine, antitumor necrosis factor, and corticosteroids. Early postoperative complications, including death, septic, and nonseptic complications were identified. A meta-analysis was also performed on the use of preoperative MTX in patients with IBD or rheumatoid arthritis.

Results: A total of 180 patients with IBD underwent abdominal surgery. A total of 15 patients received MTX either monotherapy or in combination therapy. Total early postoperative complications were identified in 71 (39%) patients, specifically 5 patients on oral MTX. A total of 51 cases (28%) of septic complications and 20 (11%) nonseptic. No significant association between the use of MTX and early postoperative complications was found. The odds ratio (OR) of complications versus no complications associated with MTX was 0.75 (95% CI, 0.25-2.29) and with azathioprine/6-mercaptopurine, OR 1.48 (95% CI, 0.77-2.84). The odds of a septic complication associated with MTX were 0.58 (95% CI, 0.09-3.73), and higher in azathioprine/6-mercaptopurine, OR 3.97 (95% CI, 1.03-15.3). Our meta-analysis also did not reveal an increased risk of postoperative complications in IBD or rheumatoid arthritis on preoperative MTX (OR 0.62, 95% CI, 0.34-1.15).

Conclusions: Preoperative MTX use does not seem to be associated with early postoperative complications in IBD.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / drug therapy
  • Azathioprine / therapeutic use
  • Colitis, Ulcerative / drug therapy*
  • Colitis, Ulcerative / surgery
  • Crohn Disease / drug therapy*
  • Crohn Disease / surgery
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Mercaptopurine / therapeutic use
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Odds Ratio
  • Postoperative Complications / epidemiology*
  • Preoperative Period
  • Retrospective Studies
  • Sepsis / epidemiology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Young Adult


  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Mercaptopurine
  • Azathioprine
  • Methotrexate