Infliximab Use Near Surgery is Safe Save

Risk factors for perioperative infections include age, comorbidity, rheumatoid arthritis and steroids to name a few; whether concurrent use of TNF inhibitor (TNFI) therapy adds to this risk has been debated. In a study of elderly patients receiving infliximab infusions, infliximab use prior to surgery did not change the risk of post-operative infections.

A retrospective cohort study using US Medicare claims data from 2007 to 2015, included RA patients treated with IV infliximab who underwent either coronary artery bypass grafting (CABG), aortic or vascular surgery, or bowel resection.  To be included, the infliximab had to be given within the 90 days prior to surgery. The primary outcome was infections and mortality in the first 30 days after surgery.

A total of 1818 RA patients were included (712 CABG, 244 vascular surgery and 862 bowel resections).

The risk of serious Post-operative infections (SIE) or death did not differ between those not taking Inflixima and those receiving it within 90 days of surgery.  Overall rates for pneumonia were 7.4–11.9%, urinary tract infection in 9.0–15.2%, surgical site infection in 3.2–18.9%, sepsis in 4.2–9.6% and death in 3.5–7.0%.

Some infliximab treated patients had a short "gap" (12–14%) werein infliximab was giving less than 2 weeks before surgery.  Overall, the timing of treatment with infliximab did not significantly impact SIE or death risk in the post operative month.