Introduction: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease (CD). We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within 12 weeks prior to an abdominal operation as compared to patients who received anti-tumor necrosis factor (TNF) agents.
Methods: A retrospective chart review of adults with CD who underwent an abdominal operation between 1/1/2015 and 5/1/2017 was performed across six sites. Surgical site infection (SSI) was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma.
Results: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar except anti-TNF patients were more likely to have received combination therapy with an immunomodulator (p=0.006). There were no significant differences in postoperative SSI (13% in ustekinumab versus 20% in anti TNF-treated patients, p=0.61) or hospital readmission rates (18% versus 10%, p=0.14), but ustekinumab-treated patients had a higher rate of return to the operating room (16% versus 5%; p=0.01). There were no significant predictors identified on multivariable analysis.
Conclusions: Of the 44 patients with CD who received ustekinumab within 12 weeks of a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.
- Journal Article