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

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7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)966-977
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Volume49
DOIs
Publication statusPublished - Jan 1 2019

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Crohn Disease
Meta-Analysis
Tumor Necrosis Factor-alpha
Incidence
Physiologic Monitoring
Therapeutics
MEDLINE
Libraries
Registries
Necrosis
Odds Ratio
Clinical Trials
Neoplasms

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

@article{7b0d9c28c06f41c58225e6ff5f56289a,
title = "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",
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.",
author = "Lin, {Yang Sheng} and Cheng, {Sheng Wei} and Wang, {Yuan Hung} and Chen, {Kee Hsin} and Fang, {Ching Ju} and Chiehfeng Chen",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/apt.15184",
language = "English",
volume = "49",
pages = "966--977",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Systematic review with meta-analysis

T2 - risk of post-operative complications associated with pre-operative exposure to anti-tumour necrosis factor agents for Crohn’s disease

AU - Lin, Yang Sheng

AU - Cheng, Sheng Wei

AU - Wang, Yuan Hung

AU - Chen, Kee Hsin

AU - Fang, Ching Ju

AU - Chen, Chiehfeng

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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U2 - 10.1111/apt.15184

DO - 10.1111/apt.15184

M3 - Review article

AN - SCOPUS:85062970943

VL - 49

SP - 966

EP - 977

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

ER -