ORIGINAL ARTICLE Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience Gianluca Rizzo & Alessandro Armuzzi & Daniela Pugliese & Alessandro Verbo & Alfredo Papa & Claudio Mattana & Gian Lodovico Rapaccini & Luisa Guidi & Claudio Coco Accepted: 3 May 2011 /Published online: 19 May 2011 # Springer-Verlag 2011 Abstract Purpose The impact of preoperative use of TNF-alpha inhibitors on postoperative complications in patients with inflammatory bowel disease (IBD) undergoing abdominal surgery is controversial. The aim of this study was to evaluate the 30-day postoperative outcomes for IBD patients treated with these drugs prior to surgery. Methods We analyzed retrospectively the incidence of short- term postoperative complications. Statistical analyses were performed to reveal the independent variables that influenced postoperative complications and the role of preoperative medical therapy with anti-TNF drugs within 12 weeks prior to surgery. Results One hundred fourteen patients (76 with Crohn's disease (CD) and 38 ulcerative colitis (UC)) underwent abdominal surgery for IBD. Fifty-four patients were treated with anti-TNF-alpha within 12 weeks prior to surgery (anti- TNF group). Postoperative mortality and morbidity were 0% and 21%, respectively. The infection rate was 15%. A significantly higher incidence of postoperative complica- tions was found in patients treated with high-dose steroids (58% vs. 17%; p =0.003) after univariate analysis. The infection rate was significantly higher in patients treated with high-dose corticosteroids (50% vs. 11%; p =0.002) and concomitant anti-TNF-alpha (60% vs. 13%; p =0.023). Multivariate analysis revealed that only therapy with high- dose corticosteroids was significantly associated with cumulative (p =0.017) and infective postoperative compli- cations (p =0.046). No significant differences were found between the anti-TNF group and the control group. Conclusion High-dose corticosteroids increased the risk of short-term postoperative cumulative and infective compli- cations. Anti-TNF drugs within 12 weeks prior to abdom- inal surgery in patients with IBD did not appear to increase the rate of postoperative complications. Keywords Anti-TNF-alpha drugs . Corticosteroids . Ulcerative colitis . Crohn's disease . Postoperative complications Introduction Anti-TNF-alpha medications are a class of biological drugs used for the treatment of patients with Crohn's disease (CD) and ulcerative colitis (UC). This class includes infliximab and adalimumab, which are IgG1 anti-TNF monoclonal antibodies (the first one is chimeric, and the second is entirely human) that exert potent anti-inflammatory effects by inducing apoptosis in inflammatory cells, and certolizu- mab pegol, which is a pegylated anti-TNF Fab antibody fragment that has proven clinical efficacy despite a lack of proapoptotic effects. All three of these drugs are effective for treating CD [1, 2]. In particular, they are indicated for patients with moderately and severely active luminal disease who have previously been steroid-refractory, Gianluca Rizzo and Alessandro Armuzzi contributed equally to this study. G. Rizzo (*) : A. Verbo : C. Mattana : C. Coco General Surgery Unit, Complesso Integrato Columbus, Catholic University, Via Moscati, 31, 00168 Rome, Italy e-mail: gianluca.rizzo1979@libero.it A. Armuzzi : D. Pugliese : A. Papa : G. L. Rapaccini : L. Guidi Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy Int J Colorectal Dis (2011) 26:1435–1444 DOI 10.1007/s00384-011-1236-2