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Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: A meta-analysis

Abstract : Background and aims: About one-third of inflammatory bowel disease (IBD) patients still require surgery. A growing number of them receive anti-tumor necrosis factor (TNF) therapy before surgery. The present meta-analysis studied the risk of postoperative complications in IBD patients treated with anti-TNF. Methods: MEDLINE was searched (up to January 2012) to identify observational studies reporting the prevalence of postoperative complications in IBD patients. The prevalence of overall, infectious, and non-infectious postoperative complications was extracted for all studies, and according to preoperative anti-TNF treatment where reported. Pooled prevalence, as well as odds ratios (ORs), with 95% confidence intervals (CIs) was calculated. Results: The search identified 86 citations. Twenty-one studies, containing 4251 subjects, reported the prevalence of postoperative complications according to preoperative anti-TNF treatment. Pooled prevalence of any postoperative complication was 21%, 35%, and 26% in Crohn's disease (CD), ulcerative colitis (UC) or inflammatory bowel disease unspecified (IBD-U) and IBD, respectively. The prevalence of any postoperative complication was increased in IBD patients who underwent preoperative anti-TNF therapy (OR: 1.25; 95% CI: 1.02–1.53). Pooled prevalence of infectious postoperative complications was 16%, 17%, and 15% in CD, UC/IBD-U and IBD, respectively. The prevalence of infectious postoperative complications was increased in CD patients who underwent preoperative anti-TNF therapy (OR: 1.45; 95% CI: 1.03–2.05). The confounding effect of concomitant therapies could not be studied. Conclusions: Preoperative anti-TNF use slightly increases the occurrence of overall postoperative complications in IBD patients, and particularly infectious complications in CD patients. Postoperative complications are not increased in UC.
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https://hal.univ-lorraine.fr/hal-01706822
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Submitted on : Monday, February 12, 2018 - 12:08:56 PM
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Vincent Billioud, Alexander Ford, Emilie Del Tedesco, Jean-Frédéric Colombel, Xavier Roblin, et al.. Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: A meta-analysis. Journal of Crohn's and Colitis, Elsevier - Oxford University Press, 2013, 7 (11), pp.853 - 867. ⟨10.1016/j.crohns.2013.01.014⟩. ⟨hal-01706822⟩

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