Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis.
BACKGROUND
Infliximab was approved for use in ulcerative colitis in recent years. It has been debated if infliximab increases the risk of post-operative complications in patients with ulcerative colitis.


OBJECTIVE
To perform a meta-analysis that examines the relationship between preoperative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis.


METHODS
We searched the PubMed and MEDLINE databases to identify observational studies on the impact of pre-operative infliximab use on short-term post-operative complications in ulcerative colitis. Infectious complications mainly included wound infection, sepsis and abscess, whereas non-infectious complications included intestinal obstruction, thromboembolism and gastrointestinal haemorrhage. Pooled odds ratios (ORs) were calculated for each relationship.


RESULTS
A total of 5 studies and 706 patients were included in our meta-analysis. Overall, we did not find a strong association between pre-operative treatment of infliximab and short-term infectious [OR 2.24, 95% confidence interval (CI) 0.63-7.95] or non-infectious (OR 0.85, 95% CI 0.50-1.45) post-operative complications in ulcerative colitis patients. On the contrary, we discovered that pre-operative infliximab use increased short-term total post-operative complications (OR 1.80, 95% CI 1.12-2.87).


CONCLUSIONS
Pre-operative infliximab use increased the risk of short-term post-operative complications. Subgroup analysis is underpowered to assess the nature of these complications but shows a trend towards increased post-operative infection.
Yang
Z
Z
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Wu
Q
Q
Wu
K
K
Fan
D
D
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D035061:Control Groups; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects; D000069285:Infliximab; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000706:statistics & numerical data; D039781:PubMed; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D000069285:Infliximab