Postoperative outcomes in Ustekinumab- treated patients undergoing abdominal operations for Crohn's disease

Amy Lightner, Nicholas P. McKenna, Chung Sang Tse, Neil Hyman, Radhika Smith, Gayane Ovsepyan, Phillip Fleshner, Kristen Crowell, Walter Koltun, Marc Ferrante, Andre D'Hoore, Nathalie Lauwers, Bram Verstockt, Antonino Spinelli, Francesca DiCandido, Laura E. H. Raffals, Kellie L. Mathis, Edward Vincent Loftus, Jr

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease [CD]. We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within the 12 weeks prior to an abdominal operation as compared with patients who received anti-tumor necrosis factor [TNF] agents. Methods: A retrospective chart review of adults with CD who underwent an abdominal operation between January 1, 2015 and May 1, 2017 was performed across six sites. Surgical site infection [SSI] was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. Results: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar, except anti-TNF patients were more likely to have received combination therapy with an immunomodulator [P = 0.006]. There were no significant differences in postoperative SSI [13% in ustekinumab versus 20% in anti TNFtreated patients, p = 0.61] or hospital readmission rates [18% versus 10%, respectively, p = 0.14], but ustekinumab-treated patients had a higher rate of return to the operating room [16% versus 5%; P = 0.01]. There were no significant predictors identified on multivariable analysis. Conclusions: Of the 44 patients with CD who received ustekinumab within the 12 weeks prior to a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.

Original languageEnglish (US)
Pages (from-to)402-407
Number of pages6
JournalJournal of Crohn's and Colitis
Volume12
Issue number4
DOIs
StatePublished - Apr 1 2018

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Crohn Disease
Surgical Wound Infection
Tumor Necrosis Factor-alpha
Abdominal Abscess
Interleukin-23
Ustekinumab
Patient Readmission
Anastomotic Leak
Soft Tissue Infections
Immunologic Factors
Operating Rooms
Interleukin-12
Therapeutics
Monoclonal Antibodies
Skin

Keywords

  • Crohn's disease
  • Postoperative outcomes
  • Surgical outcomes
  • Ustekinumab

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Postoperative outcomes in Ustekinumab- treated patients undergoing abdominal operations for Crohn's disease. / Lightner, Amy; McKenna, Nicholas P.; Tse, Chung Sang; Hyman, Neil; Smith, Radhika; Ovsepyan, Gayane; Fleshner, Phillip; Crowell, Kristen; Koltun, Walter; Ferrante, Marc; D'Hoore, Andre; Lauwers, Nathalie; Verstockt, Bram; Spinelli, Antonino; DiCandido, Francesca; Raffals, Laura E. H.; Mathis, Kellie L.; Loftus, Jr, Edward Vincent.

In: Journal of Crohn's and Colitis, Vol. 12, No. 4, 01.04.2018, p. 402-407.

Research output: Contribution to journalArticle

Lightner, A, McKenna, NP, Tse, CS, Hyman, N, Smith, R, Ovsepyan, G, Fleshner, P, Crowell, K, Koltun, W, Ferrante, M, D'Hoore, A, Lauwers, N, Verstockt, B, Spinelli, A, DiCandido, F, Raffals, LEH, Mathis, KL & Loftus, Jr, EV 2018, 'Postoperative outcomes in Ustekinumab- treated patients undergoing abdominal operations for Crohn's disease', Journal of Crohn's and Colitis, vol. 12, no. 4, pp. 402-407. https://doi.org/10.1093/ECCO-JCC/JJX163
Lightner, Amy ; McKenna, Nicholas P. ; Tse, Chung Sang ; Hyman, Neil ; Smith, Radhika ; Ovsepyan, Gayane ; Fleshner, Phillip ; Crowell, Kristen ; Koltun, Walter ; Ferrante, Marc ; D'Hoore, Andre ; Lauwers, Nathalie ; Verstockt, Bram ; Spinelli, Antonino ; DiCandido, Francesca ; Raffals, Laura E. H. ; Mathis, Kellie L. ; Loftus, Jr, Edward Vincent. / Postoperative outcomes in Ustekinumab- treated patients undergoing abdominal operations for Crohn's disease. In: Journal of Crohn's and Colitis. 2018 ; Vol. 12, No. 4. pp. 402-407.
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abstract = "Background: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease [CD]. We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within the 12 weeks prior to an abdominal operation as compared with patients who received anti-tumor necrosis factor [TNF] agents. Methods: A retrospective chart review of adults with CD who underwent an abdominal operation between January 1, 2015 and May 1, 2017 was performed across six sites. Surgical site infection [SSI] was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. Results: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar, except anti-TNF patients were more likely to have received combination therapy with an immunomodulator [P = 0.006]. There were no significant differences in postoperative SSI [13{\%} in ustekinumab versus 20{\%} in anti TNFtreated patients, p = 0.61] or hospital readmission rates [18{\%} versus 10{\%}, respectively, p = 0.14], but ustekinumab-treated patients had a higher rate of return to the operating room [16{\%} versus 5{\%}; P = 0.01]. There were no significant predictors identified on multivariable analysis. Conclusions: Of the 44 patients with CD who received ustekinumab within the 12 weeks prior to a major abdominal operation, 13{\%} experienced a 30-day postoperative SSI, not statistically different from the 20{\%} found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.",
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AU - Lightner, Amy

AU - McKenna, Nicholas P.

AU - Tse, Chung Sang

AU - Hyman, Neil

AU - Smith, Radhika

AU - Ovsepyan, Gayane

AU - Fleshner, Phillip

AU - Crowell, Kristen

AU - Koltun, Walter

AU - Ferrante, Marc

AU - D'Hoore, Andre

AU - Lauwers, Nathalie

AU - Verstockt, Bram

AU - Spinelli, Antonino

AU - DiCandido, Francesca

AU - Raffals, Laura E. H.

AU - Mathis, Kellie L.

AU - Loftus, Jr, Edward Vincent

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N2 - Background: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease [CD]. We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within the 12 weeks prior to an abdominal operation as compared with patients who received anti-tumor necrosis factor [TNF] agents. Methods: A retrospective chart review of adults with CD who underwent an abdominal operation between January 1, 2015 and May 1, 2017 was performed across six sites. Surgical site infection [SSI] was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. Results: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar, except anti-TNF patients were more likely to have received combination therapy with an immunomodulator [P = 0.006]. There were no significant differences in postoperative SSI [13% in ustekinumab versus 20% in anti TNFtreated patients, p = 0.61] or hospital readmission rates [18% versus 10%, respectively, p = 0.14], but ustekinumab-treated patients had a higher rate of return to the operating room [16% versus 5%; P = 0.01]. There were no significant predictors identified on multivariable analysis. Conclusions: Of the 44 patients with CD who received ustekinumab within the 12 weeks prior to a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.

AB - Background: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease [CD]. We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within the 12 weeks prior to an abdominal operation as compared with patients who received anti-tumor necrosis factor [TNF] agents. Methods: A retrospective chart review of adults with CD who underwent an abdominal operation between January 1, 2015 and May 1, 2017 was performed across six sites. Surgical site infection [SSI] was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. Results: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar, except anti-TNF patients were more likely to have received combination therapy with an immunomodulator [P = 0.006]. There were no significant differences in postoperative SSI [13% in ustekinumab versus 20% in anti TNFtreated patients, p = 0.61] or hospital readmission rates [18% versus 10%, respectively, p = 0.14], but ustekinumab-treated patients had a higher rate of return to the operating room [16% versus 5%; P = 0.01]. There were no significant predictors identified on multivariable analysis. Conclusions: Of the 44 patients with CD who received ustekinumab within the 12 weeks prior to a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.

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