The risks of post-operative complications following pre-operative infliximab therapy for Crohn's disease in patients undergoing abdominal surgery: a systematic review and meta-analysis

J Crohns Colitis. 2013 Dec;7(11):868-77. doi: 10.1016/j.crohns.2013.01.019. Epub 2013 Mar 5.


Background: Infliximab is an anti-TNF alpha blocker frequently utilized in the management of moderate to severe Crohn's Disease. The immunosuppressive effects of infliximab may increase the risk for post-operative complications among Crohn's Disease patients undergoing abdominal surgery. We conducted a systematic review and meta-analysis of studies comparing the rates of post-operative complications among Crohn's disease patients treated with Infliximab therapy versus alternative therapies.

Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and searched 4 electronic databases along with major conference abstract databases from inception of database until November, 2012. English-language articles and abstracts evaluating post-operative complications among Crohn's disease patients were considered eligible. We applied meta-analysis with random effects model to calculate the overall odds ratio for total major complications as well as several secondary outcomes.

Results: Data were extracted from six studies including 1159 patients among whom 413 complications were identified. The most common complications were wound infections, anastomotic leak and sepsis. There was no significant difference in the major complication rate (OR=1.59[95% CI: 0.89-2.86]; p=0.15), minor complication rate (OR=1.80 [CI: 0.87-3.71]; p=0.11), reoperation rate (OR=1.33 [CI: 0.55-3.20]; p=0.52) or 30 day mortality rate (OR=3.74 [CI: 0.56-25.16]; p=0.13) between the Infliximab and control groups.

Conclusions: This meta analysis provides some evidence that infliximab may be safe to continue in the pre-operative period without increasing the risk of post-operative complications for Crohn's disease patients undergoing abdominal surgery.

Keywords: Crohn's disease;; Infliximab;; Postoperative complications.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Case-Control Studies
  • Cohort Studies
  • Colectomy / adverse effects
  • Colectomy / methods
  • Crohn Disease / diagnosis
  • Crohn Disease / drug therapy*
  • Crohn Disease / mortality
  • Crohn Disease / surgery*
  • Female
  • Humans
  • Incidence
  • Infliximab
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Preoperative Care / adverse effects*
  • Preoperative Care / methods
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Infliximab