Biologics Before Surgery Result in Shorter Hospital Stays for Patients With UC

Patients with ulcerative colitis (UC) exposed to biologic therapeutics before colectomy or proctocolectomy are not at higher risk of postoperative complications, do not use more health care resources, and in fact stay in the hospital for one day fewer that patients who do not take these medications, according to new research.

Because biologics are immunosuppressive, it is thought that they may compromise wound healing and delay response to infections among patients who have surgery while or shortly after being exposed to these therapies. Previous studies of this concept have yielded inconclusive results.

In this retrospective cohort study, researchers sought to determine if patients with ulcerative exposed to biologics within 6 months before surgery showed higher rates of health care resource use or postoperative complications. The study team reviewed a commercial insurance database for claims between 2003 and 2016, identifying 1794 patients who underwent total colectomy with end ileostomy, total proctocolectomy with end ileostomy, or total proctocolectomy with ileal pouch-anal anastomosis. Approximately 22% of these patients had been exposed to biologic therapies in the 6 months prior to surgery.

The researchers used multivariate regression analysis after coarsened exact matching to compare the outcomes of patients who had been exposed to biologics and those who had not. The measures compared were use of health care resources—including length of hospital stay, unplanned procedures, emergency department visits, and readmissions—and complications, such as infections, hernia, wound disruption, thromboembolism, or cardiopulmonary events,  within 30 days after surgery.

The study team found that exposure to biological medications was associated with shorter hospitalizations of 7 days compared with 8 days for patients without biologic exposure. Exposure to biologics was not associated with any other difference in health care resource utilization, nor with any difference in the incidence of postoperative complications.

“Biological exposure among patients with ulcerative colitis is not associated with higher odds of postoperative complications or health care resource use,” the researchers concluded. “These data, in combination with clinical judgment and patient preferences, may aid in complex decision-making regarding operative timing, operation type, and perioperative medication management.”

—Rebecca Mashaw

Reference:

Rumer K, Dehghan MS, Sceats LA, Trickey AW, Morris AM, Kin C. Use of biological medications does not increase postoperative complications among patients with ulcerative colitis undergoing colectomy: A retrospective cohort analysis of privately insured patients. Dis Colon Rectum. 2020; 63(11): 1524-1533 doi:10.1097/DCR.0000000000001684