Meds Safe for Crohn's Surgery

Immunosuppressive therapy for Crohn's patients does not affect number who become ill with surgery

(RxWiki News) For Crohn's patients going under the knife, it's okay to take certain meds to help the immune system do its job. A recently published study found that patients given a certain drug therapy before surgery does not increase their chances of getting sick from the procedure.

Researchers led by Andrea Bafford, MD, assistant professor of surgery at the University of Maryland Medical Center, aimed to see how drugs that suppress the immune system affects the number of patients who became ill after having intestinal surgery to treat their Crohn's disease.

Of those who had surgery, 23 percent had some sickness or complication, but not from the surgery itself or from taking the drugs.  

"Talk to your doctor before surgery."

The study involved health records of 196 patients having surgery at Mount Sinai Medical Center between June 1999 and May 2010. Patients ranged from 12- to 81-years-old and a little more than half were male.

Almost two-thirds of the patients were given immunosuppressive therapy drugs, including thiopurines and anti-TNF drugs. The first drug was given within three months of surgery and the second within a month and a half of surgery.

About 24 percent of the patients received more than one drug before surgery.

Researchers took into account patients' age, gender, what kind of surgery they had, the number of abnormal masses inside their intestines and whether their surgery was urgent or planned ahead of time.

After the surgery, researchers looked at how long patients stayed in the hospital, any complications that happened or whether patients had to return to the hospital after surgery.

None of the patients died after surgery. 

In addition, 45 patients, or 23 percent of the participants, had some sort of complication, which the authors say falls in line with what previous research found.

Half the complications were due to problems in patients' blood that the drugs didn't address.

Problems included swelling and tears in the abdomen; leaks and abnormal openings inside the body and blockages in the bowels.

Patients undergoing open procedures have an almost 29 percent chance of having complications, compared to about 16 percent for laparoscopic surgery that cuts less into the body.

Patients given steroids and medications to suppress the immune system before surgery did not have excessive complications after the operation.

"This may be due to the fact that the majority of our study patients were on relatively low doses of prednisone (mean 18 mg daily, median 15 mg daily) or budesonide before surgery," the authors said in their report.

"Higher rather than lower doses of corticosteroids are more commonly associated with increased postoperative complications."

The age and gender of the patients also didn't affect the rate of complications or deaths.

"The present study provides evidence that immunosuppressive therapy, including combination therapy, does not increase the morbidity of intestinal surgery in patients with Crohn’s disease," the authors wrote in their report.

Within a month after surgery, about 38 percent of patients who had some complication were readmitted to the hospital.

Those with a complication were about 65 percent likelier to stay at the hospital more than a week, compared to 43 percent among patients without complications.

At the same time, less than 2 percent of patients who did not have any more serious problems returned to the hospital.

The authors note that their study is small and the patients' nutrition may have affected the type and timing of their surgery. Those who received the medications before surgery were younger and often had the procedure quickly with little pre-planning, which may have affected their results.

The authors do not declare any conflicts of interest. The study was published October 17 in the Journal of Clinical Gastroenterology.

Review Date: 
October 26, 2012