Perioperative Immune Suppression Management in Patients With Inflammatory Bowel Disease

摘要

Patients with inflammatory bowel disease (IBD) are at higher risk of septic and thromboembolic complications after surgery. While these patients cases are often complicated from a surgical perspective, we now also manage them with a variety ot immunosuppressive agents that can increase the risk of postsurgical complications. Whether to withhold or continue these medications in the perioperative period is the subject of ongoing debate in the IBD surgical community. While the evidence to support both approaches is mixed, it does appear that undiverted anastomoses are at an increased risk from perioperative corticosteroids and may present a greater risk for patients receiving biologic therapies for IBD. Regardless, if concern exists that a patient may not have a successful outcome from surgery, it is often prudent to wait 5 half-lives to allow the medication to wash out of the system or to consider judicious diversion at the time of the operation.