The Impact of Perioperative Immunosuppression on Post-surgical Outcomes in Patients with Inflammatory Bowel Disease.

PURPOSE: Patients with inflammatory bowel disease (IBD) often require immunosuppression and abdominal surgery for medication-refractory disease. We evaluated whether perioperative biologic/advanced therapies, corticosteroids, and immunomodulators were associated with postoperative complications after IBD-related abdominal surgery.

METHODS

This retrospective cohort included adults with chart-confirmed IBD undergoing index IBD-related abdominal surgery at a tertiary center from January 2010 to January 2024. Demographic, disease, surgical, medication, and outcome variables were abstracted. Biologic/advanced therapy exposure was defined as treatment within 8 weeks preoperatively and/or 4 weeks postoperatively, and corticosteroid and immunomodulator exposure were defined within 4 weeks before and/or after surgery. Outcomes included 30-day infection, sepsis, reoperation, readmission, and length of stay (LOS). Multivariable models adjusted for demographic, disease, surgical, and concomitant medication variables when available.

RESULTS

Among 274 patients, 181 (66%) received perioperative biologic/advanced therapy, 129 (47%) corticosteroids, and 94 (34%) immunomodulators. Biologic/advanced therapy was not associated with increased composite 30-day postoperative complications. Composite complications occurred in 37/127 (29.1%) patients receiving anti-TNFs, 5/21 (23.8%) receiving anti-integrins, and 3/13 (23.1%) receiving IL-12/23 or IL-23 inhibitors. Immunomodulators were associated with intra-abdominal infection (OR 3.6, 95% CI 1.1-12.0) and urinary tract infection (OR 4.3 95% CI 1.2-15.9), while corticosteroids were associated with sepsis (OR 11.3, 95% CI 1.2-109.8). Postoperative biologic/advanced therapy exposure was associated with shorter postoperative LOS (- 1.5 days).

CONCLUSIONS

Perioperative biologic/advanced therapy exposure was not associated with increased 30-day postoperative complications, supporting continuation when clinically indicated. Corticosteroid and immunomodulator associations with infectious complications support steroid minimization, judicious immunomodulator use, and medication-class-specific perioperative risk assessment in multidisciplinary IBD surgical care.