Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2016; 8(3): 274-283
Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.274
Post-operative abdominal complications in Crohn’s disease in the biological era: Systematic review and meta-analysis
Peter Waterland, Thanos Athanasiou, Heena Patel
Peter Waterland, Heena Patel, Department of Colorectal Surgery, Worcester Royal Hospital, Worcester, WR5 1DD, United Kingdom
Thanos Athanasiou, Department of Biosurgery and Surgical Technology, Imperial College London, London, W2 1NY, United Kingdom
Author contributions: Waterland P acquisition of data, analysis and interpretation, drafting article, final approval; Athanasiou T biostatistical analysis and interpretation, drafting article, final approval; Patel H conception and design of study, acquisition of data, analysis and interpretation of data, drafting article, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Heena Patel, MD, FRCS, Consultant Surgeon, Department of Colorectal Surgery, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, United Kingdom.
Telephone: +44-1905-763333
Received: August 8, 2015
Peer-review started: August 11, 2015
First decision: October 16, 2015
Revised: December 17, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: March 27, 2016

AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn’s disease (CD) comparing biological with no therapy.

METHODS: PubMed, Medline and Embase databases were searched to identify studies comparing post-operative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure of interest.

RESULTS: A total of 14 studies were included for meta-analysis, comprising a total of 5425 patients with CD 1024 (biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications (OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection (OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak (OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis (OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation (OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy.

CONCLUSION: Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.

Keywords: Crohn’s, Post-operative complications, Biological, Anti-tumor necrosis factor-α, Monoclonal antibody, Infliximab, Adulimimab

Core tip: Pre-operative use of anti-tumor necrosis factor alpha (TNF-α) therapy increases risks of post-operative infectious complications after surgery for Crohn’s disease, particularly wound sepsis. Surgery should be planned carefully and ideally performed after appropriate cessation of anti-TNF-α therapy to mitigate increased post-operative risks.