Evaluating the safety of using biologics in Inflammatory Bowel Disease patients undergoing elective surgery: Results from the SABRE-IBD study

Abstract

Background: There is limited evidence to guide continuation or cessation of biologics for patients with IBD undergoing IBD or non-IBD-related elective surgery, which may increase the risk of post-operative complications or IBD flares, respectively. Method(s): We undertook a multicentre observational study across the United Kingdom of IBD patients who had any moderate-To-high risk elective surgery, who were not prescribed biologics for their IBD group A], or for whom biologics had been paused pre-operatively (at least one dose missed based on dosing interval) group B], or continued pre-operatively (no dose missed) group C]. Demographics, pre-operative IBD medications, date of the last biologic dose pre-surgery, surgical procedure, date of surgery, post-operative complications and post-operative IBD flares were recorded anonymously for consecutive patients in 45 hospital trusts. Primary outcome was the rate of post-operative complications within 90 days. Secondary outcome was the rate of clinically relevant IBD flares within 90 days post-surgery. Chi-squared testing assessed statistical significance. Result(s): Data were entered for 1416 patients who had undergone surgery between August 2016 and September 2025. Most operations were colorectal (1004 patients; 70.9%, of which 88.3% were IBD-related), gynaecology (145; 10.2%) or orthopaedics (122; 8.6%). 752 (53.1%) patients were not prescribed biologics group A], 254 (17.9%) paused their biologics pre-operatively group B] and 410 (29.0%) had continued group C]. The most common recent drugs were adalimumab, infliximab, ustekinumab and vedolizumab (table 1). There were no significant differences between groups in potential confounders for post-operative complications, such as American Society of Anaesthesiology score, body mass index or pre-operative prednisolone use. Median pre-operative haemoglobin, ferritin and albumin levels were within normal ranges. There were no significant differences in general major post-operative complications A: 11.6%, B: 13.4%, C: 12.8%; p = 0.7), non-surgical site infections A: 3.1%, B: 5.1%, C: 2.5%; p = 0.2], or surgical site infections A: 6.2%, B: 5.1%, C: 6.4%; p = 0.3] between all groups. There were more post-operative IBD flares in those prescribed biologics for IBD compared to those who were not, but there were no differences between groups B and C A: 3.2%, B: 7.1%, C: 7.6%; p = 0.02]. Conclusion(s): In this large multicentre cohort, pre-operative continuation of biologics did not affect complication rates, including infection, for gastrointestinal (including IBD/non-IBD) and non-gastrointestinal operations. Patients prescribed biologics are more prone to post-operative flares but temporary biologic cessation does not seem to affect medium-Term flare risk.