ArticleDigestive diseases and sciences2026
The Impact of Perioperative Immunosuppression on Post-surgical Outcomes in Patients with Inflammatory Bowel Disease.
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePatients 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.
methodsThis 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.
resultsAmong 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).
conclusionsPerioperative 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.
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