Patients with Crohn’s disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications.
Dr Alaa El-Hussuna assessed the effect of anti-tumor necrosis factor alpha on postoperative complications in patients with Crohn’s disease undergoing abdominal surgery.
Studies were identified through electronic and manual searches.
|14 studies were identified|
|Diseases of the Colon & Rectum|
The research team included observational studies on patients with Crohn’s disease undergoing laparoscopic or open abdominal surgery.
Anti-tumor necrosis factor alpha agents were administered within 3 months before surgery.
The team's main outcome was anastomotic complications including overt dehiscence, intra-abdominal abscess, and enteric fistulas.
The researchers included 14 studies on 679 patients in the intervention (anti-tumor necrosis factor alpha) group, and 2363 controls.
Random-effects meta-analysis found no difference in anastomotic complications between the 2 groups.
There was clear heterogeneity between studies.
In subgroup analyses, the anti-tumor necrosis factor alpha increased anastomotic complications in trials with a lower risk of bias, but not in the studies with a higher bias risk.
In the overall analysis and in studies with a lower bias risk, anti-tumor necrosis factor alpha agents increased the risk of nonanastomotic surgical complications, major medical complications, and minor medical complications.
Dr El-Hussuna's team commented, "In studies with a low risk of bias, anti-tumor necrosis factor alpha agents increased the risk of anastomotic complications."
"Inadequate bias control may lead to an underestimated risk of anastomotic complications."