title: Increased risk of post-operative complications in patients with Crohn's disease treated with anti-tumour necrosis factor α agents - a systematic review.
abstract: BACKGROUND
  Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery. Biologic treatments including anti-TNF-α agents are increasingly used in the treatment of inflammatory bowel disease. Taking into consideration the biologics' mechanism of action, fears have been expressed that they might increase the rate of post-operative complications. Results from 18 retrospective studies were conflicting, and meta-analyses based on these studies did not agree. The objective of this study was to review data from present reviews and meta-analyses in an attempt to come to conclusions for the use of anti-TNF-α in Crohn's disease patients in clinical practice.
  
  
  METHODS
  Literature search using both electronic and manual searches was conducted according to a pre-defined protocol. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied.
  
  
  RESULTS
  Two systematic reviews and six meta-analyses were found. Meta-analyses that included a large number of patients and applied quality assessment showed an increased risk of overall post-operative complications and an increased rate of infectious or anastomosis-related complications in patients receiving anti-TNF-α.
  
  
  CONCLUSIONS
  The use of anti-TNF-α agents in Crohn's disease patients is associated with an increased risk of post-operative complications after abdominal surgery.
authors.affiliation: Skovbyvej 18, 2740 Skovlunde, Denmark. alaanewemail@gmail.com.
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Hussuna
authors.forename: Klaus
authors.initials: K
authors.lastname: Theede
authors.forename: Gunnar
authors.initials: G
authors.lastname: Olaison
mesh_terms: D000005:Abdomen / Q000601:surgery; D003093:Colitis, Ulcerative / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*
chemical_list: D014409:Tumor Necrosis Factor-alpha