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Aliment Pharmacol Ther. 2019 Mar 12. doi: 10.1111/apt.15184. [Epub ahead of print]

Systematic review with meta-analysis: risk of post-operative complications associated with pre-operative exposure to anti-tumour necrosis factor agents for Crohn's disease.

Lin YS1,2,3, Cheng SW1,4, Wang YH1,5, Chen KH6,7, Fang CJ8,9, Chen C1,10,11.

Author information

1
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
2
Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
3
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
4
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
5
Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
6
Post-Baccalaureate Program in Nursing, College of Nursing, Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
7
Evidence-based Knowledge Translation Centre, Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
8
Medical Library, National Cheng Kung University, Tainan, Taiwan.
9
Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
10
Department of Public Health, School of Medicine, College of Medicine, and Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
11
Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Abstract

BACKGROUND:

Post-operative complications after anti-tumour necrosis agent treatment for Crohn's disease (CD) have been analysed with conflicting results.

AIM:

To assess the effects of pre-operative anti-tumour necrosis factor (TNF) therapy on post-operative complications within 30 days post-operatively in patients with CD undergoing abdominal surgery.

METHODS:

Systematic review with meta-analysis was performed on articles found in MEDLINE, Embase, Cochrane Library, Scopus, and the International Clinical Trials Registry Platform until September 2018.

RESULTS:

Twenty studies (7115 patients) were included. Without confounder adjustment, pre-operative anti-TNF therapy in patients with CD undergoing abdominal surgery was associated with increased rates of infectious complications (unadjusted odds ratio, OR, 1.49; 95% CI, 1.08-2.06). After confounder adjustment, Pre-operative anti-TNF therapy was significantly associated with both increased rates of total and infectious complications (adjusted OR, 1.53 and 2.09; 95% CI, 1.11-2.09 and 1.19-3.65, respectively). After subgroup analyses, the association between anti-TNF agents and total complications was significant in high incidence countries (adjusted OR, 1.86; 95% CI, 1.43-2.42) but not in low incidence countries (adjusted OR, 0.77; 95% CI, 0.48-1.25).

CONCLUSIONS:

Exposure to anti-TNF agents is an independent risk factor for post-operative infectious complications in patients with CD, especially in countries with a high incidence of Crohn's disease. We suggest postponing elective surgery or carefully monitoring these patients post-operatively.

PMID:
30864199
DOI:
10.1111/apt.15184

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