Cindy C Y Law1, Deborah Koh1, Yueyang Bao2, Vipul Jairath3, Neeraj Narula4. 1. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 2. Department of Biology, McMaster University, Hamilton, Ontario, Canada. 3. Departments of Medicine, Epidemiology, and Biostatistics, Western University, London, Ontario, Canada. 4. Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.
Abstract
OBJECTIVE: To assess the impact of inflammatory bowel disease (IBD) medications on postoperative infection risk within 30 days of surgery. METHODS: We searched multiple electronic databases and reference lists of articles dating up to August 2018 for prospective and retrospective studies comparing postoperative infection risk in patients treated with an IBD medication perioperatively with the risk in patients who were not taking that medication. Outcomes were overall infectious complications and intra-abdominal infections within 30 days of surgery. RESULTS: Sixty-three studies were included. Overall infectious complications were increased in patients who received anti-tumor necrosis factor (TNF) agents (odds ratio [OR] 1.26; 95% confidence interval [CI], 1.07-1.50) and corticosteroids (OR 1.34; 95% CI, 1.25-1.44) and decreased in those who received 5-aminosalicylic acid (OR 0.63; 95% CI, 0.46-0.87). No difference was observed in those treated with immunomodulators (OR 1.08; 95% CI, 0.94-1.25) or anti-integrin agents (OR 1.06; 95% CI, 0.67-1.69). Both corticosteroids and anti-TNF agents were associated with increased intra-abdominal infection risk (OR 1.63; 95% CI, 1.33-2.00 and OR 1.46; 95% CI, 1.08-1.97, respectively), whereas no impact was observed with 5-aminosalicylates, immunomodulators, or anti-integrin therapy. Twenty-two studies had low risk of bias while the remaining studies had very high risk. CONCLUSIONS: Corticosteroids and anti-TNF agents were associated with increased overall postoperative infection risk as well as intra-abdominal infection in IBD patients, whereas no increased risk was observed for immunomodulators or anti-integrin therapy. Although these results may result from residual confounding rather than from a true biological effect, prospective studies that control for potential confounding factors are required to generate higher-quality evidence.
OBJECTIVE: To assess the impact of inflammatory bowel disease (IBD) medications on postoperative infection risk within 30 days of surgery. METHODS: We searched multiple electronic databases and reference lists of articles dating up to August 2018 for prospective and retrospective studies comparing postoperative infection risk in patients treated with an IBD medication perioperatively with the risk in patients who were not taking that medication. Outcomes were overall infectious complications and intra-abdominal infections within 30 days of surgery. RESULTS: Sixty-three studies were included. Overall infectious complications were increased in patients who received anti-tumor necrosis factor (TNF) agents (odds ratio [OR] 1.26; 95% confidence interval [CI], 1.07-1.50) and corticosteroids (OR 1.34; 95% CI, 1.25-1.44) and decreased in those who received 5-aminosalicylic acid (OR 0.63; 95% CI, 0.46-0.87). No difference was observed in those treated with immunomodulators (OR 1.08; 95% CI, 0.94-1.25) or anti-integrin agents (OR 1.06; 95% CI, 0.67-1.69). Both corticosteroids and anti-TNF agents were associated with increased intra-abdominal infection risk (OR 1.63; 95% CI, 1.33-2.00 and OR 1.46; 95% CI, 1.08-1.97, respectively), whereas no impact was observed with 5-aminosalicylates, immunomodulators, or anti-integrin therapy. Twenty-two studies had low risk of bias while the remaining studies had very high risk. CONCLUSIONS:Corticosteroids and anti-TNF agents were associated with increased overall postoperative infection risk as well as intra-abdominal infection in IBDpatients, whereas no increased risk was observed for immunomodulators or anti-integrin therapy. Although these results may result from residual confounding rather than from a true biological effect, prospective studies that control for potential confounding factors are required to generate higher-quality evidence.
Authors: Jurij Hanzel; Ahmed Almradi; Alexandra C Istl; Mei Lucy Yang; Katherine A Fleshner; Claire E Parker; Leonardo Guizzetti; Christopher Ma; Siddharth Singh; Vipul Jairath Journal: Dig Dis Sci Date: 2021-02-26 Impact factor: 3.199
Authors: Josefine Schardey; Sophie Zehl; Alina S Kappenberger; Petra Zimmermann; Florian Beigel; Tobias S Schiergens; Michael S Kasparek; Florian Kühn; Jens Werner; Ulrich Wirth Journal: Int J Colorectal Dis Date: 2022-08-01 Impact factor: 2.796