Document resource
Introduction There is limited evidence to guide continuation or cessation of biologics for inflammatory bowel disease (IBD) patients undergoing IBD or non-IBD-related elective surgery, which may increase the risk of post-operative complications or IBD flares, respectively.Methods We undertook a multicentre observational study across the UK 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 last biologic dose pre-surgery, date and type 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 of surgery. Secondary outcome was the rate of clinically relevant IBD flares within 90 days. Chi-squared testing assessed statistical significance. SABRE-IBD was led by gastroenterology and surgical trainees and delivered mainly by internal medicine and specialty trainees.Results Data were entered for 1416 patients who had undergone surgery between August 2016 and September 2025 by 183 collaborators. Most operations were colorectal (1004 patients; 70.9%, 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 biologics pre-operatively [group B] and 410 (29.0%) had continued [group C]. The most common recent drugs were adalimumab, infliximab, ustekinumab and vedolizumab. 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].Conclusions 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 surgery. Patients prescribed biologics are more prone to post-operative flares, but temporary cessation does not seem to affect medium-term flare risk. This provides much needed evidence for perioperative biologics management for all elective surgery and champions collaborative trainee-led research in IBD.