Anti-tumor necrosis factor and postoperative complications in Crohns disease: systematic review and meta-analysis

Inflammatory Bowel Disease, 04/26/2012

Preoperative infliximab treatment is associated with an increased risk of postoperative infectious complications, mostly nonlocal. A trend toward an increased risk of noninfectious and overall complications was also observed.

Methods

  • A systematic review and meta-analysis of comparative cohort studies was performed assessing postoperative complication rates in CD patients who were treated with anti-TNF antibodies within 3 months before surgery versus patients who were not.
  • The primary outcome was overall complication rate within 1 month of surgery.
  • Secondary outcomes included the rate of infectious and noninfectious complications.
  • The quality of studies was assessed based on selection of patients and controls, comparability of the study groups, and assessment of outcomes.
  • Odds ratios (OR) with 95% confidence intervals (CIs) were computed.

Results

  • A total of eight studies including 1641 patients were included in the meta-analysis.
  • Preoperative infliximab therapy in CD patients undergoing abdominal surgery was associated with a trend toward an increased rate of total complications (OR 1.72, 95% CI, 0.93-3.19).
  • Anti-TNF treatments were associated with a modestly increased risk of infectious complications (OR 1.50, 95% CI 1.08-2.08), mostly remote from the surgical site (OR 2.07 95% CI 1.30-3.30) and with a trend toward a higher rate of noninfectious complications (OR 2.00, 95% CI 0.89-4.46).

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