The risks of post-operative complications following pre-operative infliximab therapy for Crohn's disease in patients undergoing abdominal surgery: A systematic review and meta-analysis

Background: Infliximab is an anti-TNF alpha blocker frequently utilized in the management of moderate to severe Crohn's Disease. The immunosuppressive effects of infliximab may increase the risk for post-operative complications among Crohn's Disease patients undergoing abdominal surgery. We conducted a systematic review and meta-analysis of studies comparing the rates of post-operative complications among Crohn's disease patients treated with lnfliximab therapy versus alternative therapies. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and searched 4 electronic databases along with major conference abstract databases from inception of database until November, 2012. English-language articles and abstracts evaluating post-operative complications among Crohn's disease patients were considered eligible. We applied meta-analysis with random effects model to calculate the overall odds ratio for total major complications as well as several secondary outcomes. Results: Data were extracted from six studies including 1159 patients among whom 413 complications were identified. The most common complications were wound infections, anastomotic leak and sepsis. There was no significant difference in the major complication rate (OR=1.59[95% C.I.: 0.89-2.86]; p=0.15), minor complication rate (OR=1.80 [C.I.: 0.87-3.71]; p=0.11), reoperation rate (OR=1.33 [C.I.: 0.55-3.20]; p=0.52) or 30 day mortality rate (OR= 3.74 [C.I.: 0.56-25.16]; p=0.13) between the Infliximab and control groups. Conclusions: This meta analysis provides some evidence that infliximab may be safe to continue in the pre-operative period without increasing the risk of post-operative complications for Crohn's disease patients undergoing abdominal surgery. (C) 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.