Risk of Postoperative Infectious Complications From Medical Therapies in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Inflamm Bowel Dis. 2020 Nov 19;26(12):1796-1807. doi: 10.1093/ibd/izaa020.

Abstract

Objective: To assess the impact of inflammatory bowel disease (IBD) medications on postoperative infection risk within 30 days of surgery.

Methods: We searched multiple electronic databases and reference lists of articles dating up to August 2018 for prospective and retrospective studies comparing postoperative infection risk in patients treated with an IBD medication perioperatively with the risk in patients who were not taking that medication. Outcomes were overall infectious complications and intra-abdominal infections within 30 days of surgery.

Results: Sixty-three studies were included. Overall infectious complications were increased in patients who received anti-tumor necrosis factor (TNF) agents (odds ratio [OR] 1.26; 95% confidence interval [CI], 1.07-1.50) and corticosteroids (OR 1.34; 95% CI, 1.25-1.44) and decreased in those who received 5-aminosalicylic acid (OR 0.63; 95% CI, 0.46-0.87). No difference was observed in those treated with immunomodulators (OR 1.08; 95% CI, 0.94-1.25) or anti-integrin agents (OR 1.06; 95% CI, 0.67-1.69). Both corticosteroids and anti-TNF agents were associated with increased intra-abdominal infection risk (OR 1.63; 95% CI, 1.33-2.00 and OR 1.46; 95% CI, 1.08-1.97, respectively), whereas no impact was observed with 5-aminosalicylates, immunomodulators, or anti-integrin therapy. Twenty-two studies had low risk of bias while the remaining studies had very high risk.

Conclusions: Corticosteroids and anti-TNF agents were associated with increased overall postoperative infection risk as well as intra-abdominal infection in IBD patients, whereas no increased risk was observed for immunomodulators or anti-integrin therapy. Although these results may result from residual confounding rather than from a true biological effect, prospective studies that control for potential confounding factors are required to generate higher-quality evidence.

Keywords: biologic; infection; inflammatory bowel disease; postoperative.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Digestive System Surgical Procedures / adverse effects*
  • Humans
  • Immunologic Factors / adverse effects*
  • Infections / chemically induced*
  • Infections / immunology
  • Inflammatory Bowel Diseases / drug therapy*
  • Inflammatory Bowel Diseases / immunology
  • Inflammatory Bowel Diseases / surgery
  • Integrins / antagonists & inhibitors
  • Mesalamine / adverse effects
  • Odds Ratio
  • Perioperative Period
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / immunology
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Tumor Necrosis Factor Inhibitors / adverse effects

Substances

  • Adrenal Cortex Hormones
  • Immunologic Factors
  • Integrins
  • Tumor Necrosis Factor Inhibitors
  • Mesalamine