Background: Vedolizumab (VDZ), a bowel focused anti-adhesion molecule, is effectively used in patients with ulcerative colitis (UC). Preoperative use of VDZ has recently been associated with increased risk of short-term postoperative infectious complications. We assessed this risk in a single-center cohort of patients with UC undergoing (procto)colectomy with ileal pouch-anal anastomosis (IPAA).
Methods: A chart review was performed in all patients undergoing (procto)colectomy with IPAA between 2006 and September 2016. Patients receiving a permanent ileostomy were excluded. Short-term postoperative infectious complications were evaluated within 30 days after (procto)colectomy and included pouch related complications, surgical site and other infections. The comprehensive complication index (CCI) was calculated based on all complications reported within 30 days of (procto)colectomy.
Results: We identified 170 patients undergoing (procto)colectomy (46% female, median age 38 years, median disease duration 6 years). Thirty-four patients (20%) received VDZ within 14 weeks, 60 (35%) received anti-TNF within 8 weeks, 32 (19%) received a moderate-to-high dose (≥20 mg/day) of prednisone, and 71 (42%) received no therapy at time of (procto)colectomy. Surgery was laparoscopy-assisted in 131 patients (77%). Pouch construction was performed at first stage in 47 patients (28%), more frequent in patients with dysplasia/cancer (85% vs. 13%, p<0.001), and less frequent in patients under VDZ (9% vs. 32%, p=0.005), anti-TNF (15% vs. 35%, p=0.006), or steroids (0% vs. 34%, p<0.001). Pouch construction at first stage was the only independent risk factor for short-term postoperative infectious [Odds ratio 2.40 (95% CI: 1.18–4.90), p=0.016] and overall complications [3.11 (1.52–6.40), p=0.002]. As shown in Figure 1, no significant difference could be observed between different treatment categories and development of short-term postoperative complications. The CCI and postoperative hospitalization stay were comparable between each treatment category, and only elevated in patients undergoing pouch construction at first stage [20.9 (0.0–30.8) vs. 0.0 (0.0–20.9), p=0.001, and 11 (9–17) vs. 7 (5–10) days, p<0.001, respectively].
Conclusions: In this large single-center cohort of patient with UC undergoing IPAA surgery, perioperative use of vedolizumab was not associated with short-term postoperative (infectious) complications. However, in patients under biological therapy or moderate-to-high dose of steroids pouch construction should be postponed to a second stage of surgery.