Preoperative infliximab use and postoperative complications in Crohn's disease: A systematic review and meta-analysis

Background: Infliximab revolutionized the treatment paradigm of Crohn's disease (CD), but did not reduce the need for surgery. The impact of biologic agents on surgical complication rates remains debated. The aim of this study was to determine the effect of preoperative infliximab use on early postoperative complications in patients with CD undergoing abdominal surgery. Method: PubMed and Embase databases were searched to identify comparative studies that investigated postsurgical morbidity in CD patients receiving infliximab preoperatively with those not on infliximab. We used meta-analysis with random-effects model to calculate the pooled odds ratios (ORs) with 95% confidence intervals (CIs) for total complication rate as well as major, minor, infectious, and noninfectious complications. Results: A total of 18 studies involving 5769 patients included in this systematic review. There was significant association between infliximab therapy prior to surgery and total (OR = 1.45, 95% CI 1.04 -2.02; 13 studies, 2538 patients), infectious (OR = 1.47, 95% CI 1.08-1.99; 10 studies, 2116 patients) and non-infectious (OR = 2.29, 95% CI 1.14-4.61; 3 studies, 729 patients) postoperative complications respectively. There was no significant disparity in the major (OR = 1.39, 95% CI 0.85-2.27; 9 studies, 3696 patients) and minor (OR = 1.39, 95% CI 0.57-3.40; 5 studies, 753 patients) complication rates between infliximab and control groups. No publication bias was detected. Conclusion: Preoperative infliximab use modestly increases the risk of total early postoperative complications, and particularly infectious complications in CD patients. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.