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Perioperative anti-TNF biologics are not safe because they increase complications associated with surgery Feza H. Remzi FACS, FASCRS, FTTS ( Hon ) Chairman Department of Colorectal Surgery Professor of Surgery Ed and Joey Story Chair Ed and Joey Story Chair Digestive Disease Institute Cleveland Clinic Cleveland, OH Cleveland, OH

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Disclosure None

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Crohns Disease Operative Incidence Jejunoileitis 50% at 5 years; 70% at 10 years Ileocolitis 75% at 5 years; 90% at 10 years Colitis 50% at 5 years; 70% at 10 years

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Immunosuppressives Malnutrition/overall health Patient perceptions of surgery Surgical Plan

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infliximab CsA prednisone 6-MP induce remission rescue them from surgery

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Anastomotic leaks! Wound complications!!

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Infliximab and Surgical Outcome in Crohns Disease Is Infliximab use associated with a higher Risk of postoperative complications? Earlier studies were good but not without some limitations Colombel et al. Am J Gastroenterol. Marchal et al Alimentary Pharmacology & Therapeutics

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Infliximab and Surgical Outcome in Crohns Disease Colombel et al. IFX No IFX N 52 218 No difference in complications Small sample size Heterogenous study sample Limited stratification for risk factors Marchal et al IFX No IFX N 39 40 No difference in complications Small sample size Heterogenous study sample Limited stratification for risk factors

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Malnutrition/Overall Health More difficult to quantify and examine Related to length and severity of illness delayed referral for surgery Hypoalbuminemia (