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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 2/2022

01-02-2022 | Ulcerative Colitis | Original Article

Increased Risk of Infections with Anti-TNF Agents in Patients with Crohn’s Disease After Elective Surgery: Meta-Analysis

Authors: Jurij Hanzel, Ahmed Almradi, Alexandra C. Istl, Mei Lucy Yang, Katherine A. Fleshner, Claire E. Parker, Leonardo Guizzetti, Christopher Ma, Siddharth Singh, Vipul Jairath

Published in: Digestive Diseases and Sciences | Issue 2/2022

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Abstract

Background

Postoperative complication rates in patients with inflammatory bowel disease (IBD) receiving preoperative biologics have been analyzed without considering the surgical context. Emergency surgery may be associated with an increased risk of infectious complications, compared to elective operations.

Aims

To conduct a systematic review and meta-analysis investigating the relationship between preoperative biologic therapy and postoperative outcomes in Crohn’s disease (CD) and ulcerative colitis (UC), focusing on elective surgery.

Methods

Electronic databases were searched up to February 12, 2020, for studies of patients with IBD undergoing elective abdominal surgery receiving biologic therapy within 3 months before surgery compared to no therapy, or another biologic therapy. Certainty of evidence was evaluated using GRADE. The primary outcomes were the rate of infections and total complications within 30 days. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results

Thirty-three studies were included. Preoperative treatment with anti-tumor necrosis factor (TNF) therapy in patients with CD undergoing elective surgery was associated with increased odds of infection (OR 2.05; 95% CI 1.40–3.01), but not total complications (OR 1.03; 95% CI 0.71–1.51). In elective surgery for UC, preoperative anti-TNF therapy was not associated with infectious (OR 1.03; 95% CI 0.34–3.07) or total complications (OR 0.67; 95% CI 0.29–1.58). Limited data indicate that emergency surgery did not significantly affect the rate of complications.

Conclusions

Anti-TNF therapy prior to elective surgery may increase the odds of postoperative infection in CD, although the certainty of evidence is very low. More evidence is needed, particularly for newer biologics.
Appendix
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Metadata
Title
Increased Risk of Infections with Anti-TNF Agents in Patients with Crohn’s Disease After Elective Surgery: Meta-Analysis
Authors
Jurij Hanzel
Ahmed Almradi
Alexandra C. Istl
Mei Lucy Yang
Katherine A. Fleshner
Claire E. Parker
Leonardo Guizzetti
Christopher Ma
Siddharth Singh
Vipul Jairath
Publication date
01-02-2022
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 2/2022
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-021-06895-6

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