Meta‐analysis: peri‐operative anti‐TNFα treatment and post‐operative complications in patients with inflammatory bowel disease
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SummaryBackgroundThe impact of peri‐operative use of TNFα antagonists on post‐operative complications such as infection and wound healing is controversial.AimTo conduct a systematic review and meta‐analysis to assess the impact of peri‐operative use of TNFα antagonists on post‐operative complications such as infection and wound healing in patients with inflammatory bowel disease (IBD).MethodsA literature search identified studies that investigated post‐operative outcomes in patients with IBD using TNFα antagonists. The primary outcome was the rate of post‐operative infectious complications. Secondary outcomes included the rates of non‐infectious complications and total complications. Odds ratios (OR) with 95% confidence intervals (CI) are reported.ResultsOverall, 18 studies with 4659 participants were eligible for inclusion. Patients with IBD using preoperative anti‐TNFα therapies had significant increases in post‐operative infectious [OR 1.56 (95% CI, 1.09–2.24)], non‐infectious [OR 1.57 (95% CI, 1.14–2.17)] and total complications [OR 1.73 (95% CI, 1.23–2.43)]. Studies limited to patients with Crohn's disease demonstrated a statistically significant increase in infectious (OR 1.93, 95% CI 1.28–2.89) and total (OR 2.19, 95% CI 1.69–2.84) complications, and a trend towards increase in non‐infectious complications (OR 1.73, 95% CI 0.94–3.17). Studies of patients with ulcerative colitis did not demonstrate significant increases in infectious (OR 1.39, 95% CI 0.56–3.45), non‐infectious (OR 1.40, 95% CI 0.68–2.85), or total complications (OR 1.10, 95% CI 0.81–1.47).ConclusionAnti‐TNFα therapies appear to increase the risk of post‐operative complications. The increase in risk is small, and may well reflect residual confounding rather than a true biological effect. Nevertheless, physicians should exercise caution when continuing biological therapies during the peri‐operative period.
