TY - JOUR
T1 - Risk of post-operative surgical site infections after vedolizumab vs anti-tumour necrosis factor therapy
T2 - a propensity score matching analysis in inflammatory bowel disease
AU - Park, K. T.
AU - Sceats, L.
AU - Dehghan, M.
AU - Trickey, A. W.
AU - Wren, A.
AU - Wong, J. J.
AU - Bensen, R.
AU - Limketkai, B. N.
AU - Keyashian, K.
AU - Kin, C.
N1 - Funding Information:
Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We thank Lesley Park, Isabella Chu and Valerie Meausoone at the Population Health Sciences for their collaboration and technical support. We also thank Jason Bentley at Stanford University’s Quantitiative Statistical Unit for statistical expertise.
Funding Information:
Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We thank Lesley Park, Isabella Chu and Valerie Meausoone at the Population Health Sciences for their collaboration and technical support. We also thank Jason Bentley at Stanford University's Quantitiative Statistical Unit for statistical expertise. Declaration of personal interests: KTP has received research support from Janssen, Takeda, AbbVie Inc. unrelated to this work, and is supported by NIDDK094868 and Bacher-English Family Grant for this research. The remaining authors have no conflicts of interests to disclose. No form of payment or honorarium was given to any contributor for manuscript preparation or production. Declaration of funding interests: None.
Funding Information:
Declaration of personal interests: KTP has received research support from Janssen, Takeda, AbbVie Inc. unrelated to this work, and is supported by NIDDK094868 and Bacher-English Family Grant for this research. The remaining authors have no conflicts of interests to disclose. No form of payment or honorarium was given to any contributor for manuscript preparation or production. Declaration of funding interests: None.
Publisher Copyright:
© 2018 John Wiley & Sons Ltd
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/8
Y1 - 2018/8
N2 - Background: Perioperative vedolizumab (VDZ) and anti-tumour necrosis factor (TNFi) therapies are implicated in causing post-operative complications in inflammatory bowel disease (IBD). Aim: To compare the risk of surgical site infections (SSIs) between VDZ- and TNFi-treated IBD patients in propensity-matched cohorts. Methods: The Optum Research Database was used to identify IBD patients who received VDZ or TNFi within 30 days prior to abdominal surgery between January 2015 and December 2016. The date of IBD-related abdominal surgery was defined as the index date. SSIs were determined by ICD-9/10 and CPT codes related to superficial wound infections or deep organ space infections after surgery. Propensity score 1:1 matching established comparable cohorts based on VDZ or TNFi exposure before surgery based on evidence-based risk modifiers. Results: The propensity-matched sample included 186 patients who received pre-operative biologic therapy (VDZ, n = 94; TNFi, n = 92). VDZ and TNFi cohorts were similar based on age, gender, IBD type, concomitant immunomodulator exposure, chronic opioid or corticosteroid therapy, Charlson Comorbidity Index and malnutrition. VDZ patients were more likely to undergo an open bowel resection with ostomy. After propensity score matching, there was no significant difference in post-operative SSIs (TNFi 12.0% vs VDZ 14.9%, P = 0.56). Multivariable analysis indicated that malnutrition was the sole risk factor for developing SSI (OR 3.1, 95% CI 1.11-8.71) regardless of the type of biologic exposure. Conclusion: In the largest, risk-adjusted cohort analysis to date, perioperative exposure to VDZ therapy was not associated with a significantly higher risk of developing an SSI compared to TNFi therapy.
AB - Background: Perioperative vedolizumab (VDZ) and anti-tumour necrosis factor (TNFi) therapies are implicated in causing post-operative complications in inflammatory bowel disease (IBD). Aim: To compare the risk of surgical site infections (SSIs) between VDZ- and TNFi-treated IBD patients in propensity-matched cohorts. Methods: The Optum Research Database was used to identify IBD patients who received VDZ or TNFi within 30 days prior to abdominal surgery between January 2015 and December 2016. The date of IBD-related abdominal surgery was defined as the index date. SSIs were determined by ICD-9/10 and CPT codes related to superficial wound infections or deep organ space infections after surgery. Propensity score 1:1 matching established comparable cohorts based on VDZ or TNFi exposure before surgery based on evidence-based risk modifiers. Results: The propensity-matched sample included 186 patients who received pre-operative biologic therapy (VDZ, n = 94; TNFi, n = 92). VDZ and TNFi cohorts were similar based on age, gender, IBD type, concomitant immunomodulator exposure, chronic opioid or corticosteroid therapy, Charlson Comorbidity Index and malnutrition. VDZ patients were more likely to undergo an open bowel resection with ostomy. After propensity score matching, there was no significant difference in post-operative SSIs (TNFi 12.0% vs VDZ 14.9%, P = 0.56). Multivariable analysis indicated that malnutrition was the sole risk factor for developing SSI (OR 3.1, 95% CI 1.11-8.71) regardless of the type of biologic exposure. Conclusion: In the largest, risk-adjusted cohort analysis to date, perioperative exposure to VDZ therapy was not associated with a significantly higher risk of developing an SSI compared to TNFi therapy.
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U2 - 10.1111/apt.14842
DO - 10.1111/apt.14842
M3 - Article
AN - SCOPUS:85049794025
VL - 48
SP - 340
EP - 346
JO - Alimentary Pharmacology and Therapeutics
JF - Alimentary Pharmacology and Therapeutics
SN - 0269-2813
IS - 3
ER -