Effects Of Preoperative Anti-Tumour Necrosis Factor Alpha Infusion Timing On Postoperative Surgical Site Infection In Inflammatory Bowel Disease: A Systematic Review And Meta-Analysis

Background Anti-tumour necrosis factor alpha agents (anti-TNF-alpha) have been widely used in patients with inflammatory bowel disease (IBD). However, few published meta-analyses have focused on timing of the last infusion before surgery. We evaluated the relationship between preoperative anti-TNF-alpha timing and postoperative surgical site infection to provide additional evidence for surgeons to choose appropriate dates for surgery.Methods We searched from inception until January 2019 for studies that documented postoperative complications of adults with IBD who underwent preoperative anti-TNF-alpha treatment. Primary outcomes of included studies were the odds ratios of preoperative anti-TNF-alpha time frames (4, 8 and 12 weeks). In addition, surgical site infection and its subtypes (anastomotic leakage, abscesses and wound infection) were analysed.Results Twenty-seven publications were included. No significant difference between anti-TNF-alpha and control cohorts was observed for most postoperative surgical site infections (or its subtypes) when the preoperative anti-TNF-alpha infusion time window was within 4, 8 or 12 weeks. Additionally, no significant difference in postoperative complications was observed between preoperative anti-TNF-alpha windows of within four weeks and more than four weeks.Conclusions In terms of surgical site infection and its subtypes, anti-TNF-alpha may be safe for ulcerative colitis and Crohn's disease patients who receive their last infusion of anti-TNF-alpha more than four weeks before surgery. We also found no evidence that anti-TNF-alpha was a risk factor when administered within four weeks, with the exception of subgroup results from a single study. Stratified by time window, use of anti-TNF-alpha until surgery has the potential to become a more considered strategy in clinical practice.