Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: A meta-analysis

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• 作者：Vincent Billioud ; Alex ; er C. Ford ; Emilie Del Tedesco ; Jean-Fr¨¦d¨¦ric Colombel ; Xavier Roblin ; Laurent Peyrin-Biroulet
• 关键词：Anti-TNF¦Á ; Surgery ; Complication
• 刊名：Journal of Crohn's and Colitis
• 出版年：2013
• 出版时间：1 December, 2013
• 年：2013
• 卷：7
• 期：11
• 页码：853-867
• 全文大小：782 K

文摘

Background and aims

About one-third of inflammatory bowel disease (IBD) patients still require surgery. A growing number of them receive anti-tumor necrosis factor (TNF) therapy before surgery. The present meta-analysis studied the risk of postoperative complications in IBD patients treated with anti-TNF.

Methods

MEDLINE was searched (up to January 2012) to identify observational studies reporting the prevalence of postoperative complications in IBD patients. The prevalence of overall, infectious, and non-infectious postoperative complications was extracted for all studies, and according to preoperative anti-TNF treatment where reported. Pooled prevalence, as well as odds ratios (ORs), with 95 % confidence intervals (CIs) was calculated.

Results

The search identified 86 citations. Twenty-one studies, containing 4251 subjects, reported the prevalence of postoperative complications according to preoperative anti-TNF treatment. Pooled prevalence of any postoperative complication was 21 % , 35 % , and 26 % in Crohn's disease (CD), ulcerative colitis (UC) or inflammatory bowel disease unspecified (IBD-U) and IBD, respectively. The prevalence of any postoperative complication was increased in IBD patients who underwent preoperative anti-TNF therapy (OR: 1.25; 95 % CI: 1.02-1.53). Pooled prevalence of infectious postoperative complications was 16 % , 17 % , and 15 % in CD, UC/IBD-U and IBD, respectively. The prevalence of infectious postoperative complications was increased in CD patients who underwent preoperative anti-TNF therapy (OR: 1.45; 95 % CI: 1.03-2.05). The confounding effect of concomitant therapies could not be studied.

Conclusions

Preoperative anti-TNF use slightly increases the occurrence of overall postoperative complications in IBD patients, and particularly infectious complications in CD patients. Postoperative complications are not increased in UC.