Meta-analysis: effect of preoperative infliximab use on early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery

Background Infliximab is widely used in severe and refractory ulcerative colitis (UC). The results of clinical studies are inconsistent on whether preoperative infliximab use increases early postoperative complications in UC patients. Aim To determine the clinical safety and efficacy of preoperative infliximab treatment in UC patients with regard to short-term outcomes following abdominal surgery. Methods PubMed, Embase databases were searched for controlled observational studies comparing postsurgical morbidity in UC patients receiving infliximab preoperatively with those not on infliximab. The primary endpoint was total complication rate. Secondary endpoints included the rate of infectious and non-infectious complications. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) as summary measures. Results A total of 13 studies involving 2933 patients were included in our meta-analysis. There was no significant association between infliximab therapy preoperatively and total (OR=1.09, 95% CI: 0.871.37, P=0.47), infectious (OR=1.10, 95% CI: 0.512.38, P=0.81) and non-infectious (OR=1.10, 95% CI: 0.761.59, P=0.61) postoperative complications respectively. Infliximab might be a protective factor against infection for the use within 12weeks prior to surgery (OR=0.43, 95% CI: 0.220.83, P=0.01). No publication bias was found. Conclusion Preoperative infliximab use does not increase the risk of early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery.