A125 PERIOPERATIVE ANTI-TNFα AGENTS AND POST-OPERATIVE INFECTIOUS COMPLICATIONS IN ELECTIVE SURGICAL IBD PATIENTS

• Published in: Journal of the Canadian Association of Gastroenterology Vol. 2; no. Supplement_2; pp. 251 - 252
• Main Authors: Istl, A C, Yang, M, Parker, C E, Fleshner, K, Guizzetti, L, Jairath, V
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15-03-2019
• Subjects: Posters Of Distinction
• DOI: 10.1093/jcag/gwz006.124
• EISSN: 2515-2092
• ISSN: 2515-2084

Abstract
Background
Biologic agents are commonly interrupted prior to surgical intervention for inflammatory bowel disease (IBD) to avoid risk of infection. Previous reviews report increased rates of post-operative infections, however, these included patients undergoing emergent surgeries, which have an inherently higher complication risk.
Aims
To conduct a systematic review and meta-analysis aims to quantify the risk of post-operative infection in IBD patients on biologic therapy undergoing elective surgery.
Methods
EMBASE, Medline, Cochrane CENTRAL, clinialtrials.gov, and the International Clinical Trials Registry Platform were searched without language restriction.
Studies comparing infection rates for IBD patients on and off biologic therapy undergoing elective (non-emergent) surgery were eligible. The primary outcome was any post-operative infection. Secondary outcomes included overall complications and rates of specific infections. Meta-analyses were performed using a random-effects models. Studies were weighted by the inverse variance method. Pooled risk ratios were calculated for infectious complications, overall complications, and specific infectious outcomes.
Results
Fourteen studies totaling 3544 patients were included. Six assessed Crohn’s disease (CD), five assessed ulcerative colitis (UC), and three assessed both. All studies examined outcomes after elective surgeries for IBD. Infliximab was the intervention in eight studies, adalimumab in one, and five assessed any anti-TNFa. Pooled estimates of infectious complication rates were 13.7% [95% CI 8.9, 20.6] and 16.7% [95% CI 9.4, 27.8] in the control and therapy groups respectively, [risk difference 0.08% [95% CI -10.8, 11.0, p=0.99]]. For total complications, the between group risk difference was 3.5% [95% CI -1.3, 8.3, p=0.15]. No significant difference was identified between control and therapy groups for anastomotic leak, surgical site infection, urinary tract infection, nosocomial pneumonia, or C. difficile infection.
Conclusions
In the setting of elective surgery, no difference in the risk of post-operative infections or other complications was observed in IBD on biologic therapy at the time of surgery versus those who were not.
Pooled analysis of studies reporting overall infectious complications. Absolute risk difference between groups is 0.08% [95% CI -10.8, 11.0, p=0.99]. RD - risk difference. Heterogeneity was moderate to high.
Funding Agencies
None