Preoperative TNFi Not Associated With Postoperative Infections in IBD

Mixed race woman holding medication pills
Researchers sought to determine if receiving treatment with TNF inhibitors prior to surgery would increase the risk for postoperative infection.

The use of tumor necrosis factor inhibitors (TNFi) within 12 weeks before surgery was not associated with any infection or surgical site infection (SSI) 30 days postoperatively in patients with inflammatory bowel disease (IBD) who were undergoing intra-abdominal surgery, according to study findings published in Gastroenterology.

For the analysis, researchers conducted a multicenter, observational study, called “Prospective Cohort of Ulcerative Colitis and Crohn’s Disease Patients Undergoing Surgery to Identify Risk Factors for Post-Operative INfection I (PUCCINI)” ( Identifier: NCT02054533). From September 2014 to June 2017, researchers enrolled patients undergoing intra-abdominal surgery for IBD with the primary goal of determining whether preoperative exposure to TNFi was an independent risk factor for postoperative infectious complications up to 30 days after surgery.

The primary outcome was any infection within 30 days of surgery. SSIs were defined according to Centers for Disease Control and Prevention criteria and classified as deep incisional, superficial incisional, or organ/space infections. Non-SSIs were classified as sepsis, bacteremia, pneumonia, urinary tract infection, fever greater than 101.5° F without an identifiable source, or other. The prespecified primary definition of TNFi exposure was patient-reported use of TNFi within 12 weeks before surgery.

A total of 947 patients (median age, 39 years; 52.2% men) were included, with a median disease duration of 10 years. Of the cohort, 382 patients (40.3%) reported receiving treatment with at least 1 TNFi within 12 weeks of surgery. Most patients who received TNFi before surgery received adalimumab or infliximab.

No difference was observed in the primary outcome of any postoperative infection between patients with TNFi use within 12 weeks of surgery and those not using TNFi preoperatively (18.1% vs 20.2%, respectively, P =.469). In addition, no difference was found in SSI between patients reporting TNFi use within 12 weeks of surgery and those who did not use TNFi preoperatively (12.0% vs 12.6%, respectively, P =.889). No significant differences occurred in SSIs by preoperative TNFi use.

Current TNFi exposure was not associated with any infection (odds ratio [OR], 1.050; 95% CI, 0.716-1.535; P =.80) or SSI (OR, 1.249; 95% CI, 0.793-1.960; P =.34), according to multivariable analysis.

Study limitations included nonconsecutive patient enrollment and participation of mostly academic centers that may affect the generalizability of the findings.

“Preoperative use of TNFi should not affect surgical decisions in most IBD patients,” the researchers noted. “Instead, focus should be placed on modifiable risk factors such as smoking and preoperative systemic corticosteroid use.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Cohen BL, Fleshner P, Kane SV, et al. Prospective cohort study to investigate the safety of preoperative tumor necrosis factor inhibitor exposure in patients with inflammatory bowel disease undergoing intra-abdominal surgery. Gastroenterology. Published online April 10, 2022. doi:10.1053/j.gastro.2022.03.057

This article originally appeared on Gastroenterology Advisor