SP 8.17 Safety of Continuing Biological Therapies in IBD Patients Undergoing Elective Surgery: The UK Multicentre SABRE-IBD Study
Aamir Saifuddin, Roxanna Zakeri, Michala Pettitt, Bryar Kadir, Laura Magill, Shaji SebastianAbstract
Background
Evidence guiding peri-operative continuation or cessation of biologics in inflammatory bowel disease (IBD) is limited. Continuation may increase post-operative complications, whereas interruption may precipitate disease flares.
Methods
We conducted a trainee-led and -delivered, national, multicentre observational study of IBD patients undergoing moderate-to-high risk elective surgery. Patients were stratified into: no biologic therapy (A), biologics paused pre-operatively (≥1 missed dose) (B), or biologics continued (C). Demographics, medications, operative details, complications and flares were recorded anonymously for consecutive cases in 45 NHS trusts. Primary outcome was 90-day post-operative complication rate; secondary outcome was 90-day clinically-relevant IBD flares.
Results
Data were available for 1,416 patients who underwent surgery August 2016–September 2025. Most procedures were colorectal (70.9%; 88.3% IBD-related), gynaecological (10.2%) and orthopaedic (8.6%). Overall, 53.1% were not on biologics (A), 17.9% paused (B), and 29.0% continued (C). Baseline risk factors, including ASA grade, BMI and pre-operative prednisolone use, were comparable. Median pre-operative haemoglobin, ferritin and albumin were normal. No significant differences were observed in major complications (A 11.6%, B 13.4%, C 12.8%; p=0.7), non-surgical site infections (3.1%, 5.1%, 2.5%; p=0.2) or surgical site infections (6.2%, 5.1%, 6.4%; p=0.3). Post-operative flares were more frequent in biologic-treated patients overall versus non-biologic patients, but did not differ between paused and continued groups (A 3.2%, B 7.1%, C 7.6%; p=0.02).
Conclusions
In this large multicentre cohort, continuing biologics pre-operatively did not increase complications or infection risk across gastrointestinal and non-gastrointestinal surgery. Although biologic-treated patients experienced more post-operative flares, temporary cessation did not affect flare risk.