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

<jats:title>Summary</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The impact of peri‐operative use of <jats:styled-content style="fixed-case">TNF</jats:styled-content>α antagonists on post‐operative complications such as infection and wound healing is controversial.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To conduct a systematic review and meta‐analysis to assess the impact of peri‐operative use of <jats:styled-content style="fixed-case">TNF</jats:styled-content>α antagonists on post‐operative complications such as infection and wound healing in patients with inflammatory bowel disease (<jats:styled-content style="fixed-case">IBD</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A literature search identified studies that investigated post‐operative outcomes in patients with <jats:styled-content style="fixed-case">IBD</jats:styled-content> using <jats:styled-content style="fixed-case">TNF</jats:styled-content>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 (<jats:styled-content style="fixed-case">OR</jats:styled-content>) with 95% confidence intervals (<jats:styled-content style="fixed-case">CI</jats:styled-content>) are reported.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 18 studies with 4659 participants were eligible for inclusion. Patients with <jats:styled-content style="fixed-case">IBD</jats:styled-content> using preoperative anti‐<jats:styled-content style="fixed-case">TNF</jats:styled-content>α therapies had significant increases in post‐operative infectious [<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.56 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.09–2.24)], non‐infectious [<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.57 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.14–2.17)] and total complications [<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.73 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.23–2.43)]. Studies limited to patients with Crohn's disease demonstrated a statistically significant increase in infectious (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.93, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.28–2.89) and total (<jats:styled-content style="fixed-case">OR</jats:styled-content> 2.19, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.69–2.84) complications, and a trend towards increase in non‐infectious complications (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.73, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.94–3.17). Studies of patients with ulcerative colitis did not demonstrate significant increases in infectious (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.39, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.56–3.45), non‐infectious (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.40, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.68–2.85), or total complications (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.10, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.81–1.47).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Anti‐<jats:styled-content style="fixed-case">TNF</jats:styled-content>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.</jats:p></jats:sec>