Current belief and practice of Victorian gastroenterologists regarding perioperative immunomodulator therapy in the perioperative period in patients with IBD.

Abstract

Background: Immunomodulatory therapy (thiopurines, TNF antagonists and corticosteroids) is extensively used in the medical management of inflammatory bowel disease (IBD). Patients treated with these agents frequently require surgery for both refractory disease and non-IBD indications. Whilst extensive evidence exists for corticosteroids increasing the risk of post-operative infectious complications, conflicting evidence exists regarding the effects of thiopurine therapy and TNF antagonists (biologics) on post-operative infection risk. 1 There has been no prior Australian studies examining Gastroenterologists' practice with respect to perioperative management of immunomodulator therapy in patients with IBD. Aim(s): To gain insight into current belief and practice of Victorian Gastroenterologists with respect to perioperative use of immunomodulator therapy in IBD patients. Method(s): An online survey was sent to Victorian Gastroenterologists with appointments at major public hospitals. The survey consisted of 15 questions focused on current belief and practice regarding perioperative use of thiopurines, biologic therapy and prednisolone in IBD patients. All replies were anonymous. Result(s): We obtained 41 responses from the online survey. The percentages of respondents who believed thiopurines, biologic therapy and corticosteroids are associated with an increased post- operative infection risk were 20%, 45% and 95% respectively. In the setting of non - emergent abdominal surgery, 10%, 22.5%, and 72.5% of gastroenterologists recommend stopping thiopurines, biologic therapy and corticosteroids respectively prior to surgery. With respect to elective non-abdominal surgery, 5.1%, 10.3% and 56.4% of the respondents recommended ceasing thiopurines, biologic therapy and corticosteroids respectively prior to surgery. Among those who recommended ceasing thiopurines prior to surgery, most recommend ceasing the medication 1-30 days prior to surgery and restarting 1-7 days after surgery. Among those who recommended ceasing biologic therapy, the majority of the respondents recommended ceasing it 8-30 days prior and restarting it 8-30 days after surgery. Conclusion(s): The majority of gastroenterologists do not believe thiopurines and biologic therapy increases post-operative infection risk. This is consistent with the findings of most studies which have examined the post-operative infection risk associated with these agents. 2 Most gastroenterologists, including many who believe thiopurines and biologic therapy increases post-operative risk, continue with these medications through the perioperative period.