Risk of Postoperative Surgical Site Infections after Vedolizumab versus Anti-Tumor Necrosis Factor Therapy: A Propensity-Score Matching Analysis in Inflammatory Bowel Disease

Abstract

Background

Perioperative vedolizumab (VDZ) and anti-tumor necrosis factor (TNFi) therapies are implicated in causing postoperative 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 preoperative 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 postoperative 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.