OP012 Perioperative use of vedolizumab is not associated with short-term postoperative infectious complications in patients with ulcerative colitis undergoing (procto)colectomy with ileal pouch-anal anastomosis

Abstract

Background: Vedolizumab (VDZ), a bowel focused anti-adhesion molecule, is effectively used in patients with ulcerative colitis (UC). Preoperative use of VDZ has recently been associated with in-creased risk of short-term postoperative infectious complications. We assessed this risk in a single-center cohort of patients with UC undergoing (procto)colectomy with ileal pouch-anal anastomosis (IPAA). Methods: A chart review was performed in all patients undergoing (procto)colectomy with IPAA between 2006 and September 2016. Patients receiving a permanent ileostomy were excluded. Short-term postoperative infectious complications were evaluated within 30 days after (procto)colectomy and included pouch related complica-tions, surgical site and other infections. The comprehensive compli-cation index (CCI) was calculated based on all complications reported within 30 days of (procto)colectomy. Results: We identified 170 patients undergoing (procto)colectomy (46% female, median age 38 years, median disease duration 6 years). Thirty-four patients (20%) received VDZ within 14 weeks, 60 (35%) received anti-TNF within 8 weeks, 32 (19%) received a moderate-to-high dose (≥20 mg/day) of prednisone, and 71 (42%) received no therapy at time of (procto)colectomy. Surgery was laparoscopy-assisted in 131 patients (77%). Pouch construction was performed at first stage in 47 patients (28%), more frequent in patients with dysplasia/cancer (85% vs. 13%, p<0.001), and less frequent in pa-tients under VDZ (9% vs. 32%, p=0.005), anti-TNF (15% vs. 35%, p=0.006), or steroids (0% vs. 34%, p<0.001). Pouch construction at first stage was the only independent risk factor for short-term post-operative infectious [Odds ratio 2.40 (95% CI: 1.18-4.90), p=0.016] and overall complications [3.11 (1.52-6.40), p=0.002]. As shown in, no significant difference could be observed between different treatment categories and development of short-term postoperative complications. The CCI and postoperative hospitalization stay were comparable between each treatment category, and only elevated in patients undergoing pouch construction at first stage [20.9 (0.0-30.8) vs. 0.0 (0.0-20.9), p=0.001, and 11 (9-17) vs. 7 (5-10) days, p<0.001, respectively]. Conclusions: In this large single-center cohort of patient with UC undergoing IPAA surgery, perioperative use of vedolizumab was not associated with short-term postoperative (infectious) complications. However, in patients under biological therapy or moderate-to-high dose of steroids pouch construction should be postponed to a second stage of surgery.