Meta-analysis: peri-operative anti-TNF treatment and post-operative complications in patients with inflammatory bowel disease

Background The impact of peri-operative use of TNF antagonists on post-operative complications such as infection and wound healing is controversial. Aim To conduct a systematic review and meta-analysis to assess the impact of peri-operative use of TNF antagonists on post-operative complications such as infection and wound healing in patients with inflammatory bowel disease (IBD). Methods A literature search identified studies that investigated post-operative outcomes in patients with IBD using TNF 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 (OR) with 95% confidence intervals (CI) are reported. Results Overall, 18 studies with 4659 participants were eligible for inclusion. Patients with IBD using preoperative anti-TNF therapies had significant increases in post-operative infectious [OR 1.56 (95% CI, 1.092.24)], non-infectious [OR 1.57 (95% CI, 1.142.17)] and total complications [OR 1.73 (95% CI, 1.232.43)]. Studies limited to patients with Crohn's disease demonstrated a statistically significant increase in infectious (OR 1.93, 95% CI 1.282.89) and total (OR 2.19, 95% CI 1.692.84) complications, and a trend towards increase in non-infectious complications (OR 1.73, 95% CI 0.943.17). Studies of patients with ulcerative colitis did not demonstrate significant increases in infectious (OR 1.39, 95% CI 0.563.45), non-infectious (OR 1.40, 95% CI 0.682.85), or total complications (OR 1.10, 95% CI 0.811.47). Conclusion Anti-TNF 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.