Meta‐analysis: peri‐operative anti‐ TNF α treatment and post‐operative complications in patients with inflammatory bowel disease

Abstract

Summary: Background: The impact of peri‐operative use of TNF α antagonists on post‐operative complications such as infection and wound healing is controversial. Aim: To conduct a systematic review and meta‐analysis to assess the impact of peri‐operative use of TNF α antagonists on post‐operative complications such as infection and wound healing in patients with inflammatory bowel disease ( IBD ). Methods: A literature search identified studies that investigated post‐operative outcomes in patients with IBD using TNF α 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. Results: Overall, 18 studies with 4659 participants were eligible for inclusion. Patients with IBD using preoperative anti‐ TNF α 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). Conclusion: Anti‐ TNF α 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.