Infliximab Does Not Increase Perioperative Infection Save

Staying on a TNF inhibitor (TNFi) throughout major surgery has generatlly been associated with higher rates of perioperative infection (https://buff.ly/2iBFVjp).  On the other hand, discontinuation of the TNFi prior to surgery is associated with lower rates of  infection (https://buff.ly/2iAFZQf)

George and colleagues analyzed the timing of inflixiamb discontinuation before elective arthroplasty and found that infliximab given within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short  or long-term serious infection. 

Infection risk was primarily associated with glucocorticoid use, especially >10 mg/day. The 30-day infection risk was double for short term infection (OR 2.11; 95% CI 1.30–3.40) and long term prosthetic infections (HR 2.70; 95% CI 1.30–5.60). Other risk factors for infection included elderly age, comorbidities, revision surgery, and previous hospitalized infection.

They examined infliximab patients hospitalized for infection (within 30 days) and found an event rate of 6.3% (270 out of 4,288 surgeries) They then compared infliximab use - those stopping infliximab <4 weeks of surgery and compared this cohort to those stopping infliximab versus longer 8–12 weeks.  The overall infection rate did not differ between groups and the long term prosthetic infection rates were also similar between group (2.9 per 100 person-years).