Does perioperative biological therapy increase 30-day post-operative complication rates in inflammatory bowel disease patients undergoing intra-abdominal surgery? A systematic review

Safety Analysis of Preoperative Anti-TNF-α Therapy in Pediatric IBD After Intestinal Resection: A Systematic Review and Meta-analysis

BACKGROUND

Biological agents have transformed the management of inflammatory bowel disease (IBD). However, intestinal resection is still unavoidable in complicated IBD. It is still under debate whether antitumor necrosis factor (TNF)-α is related to higher postoperative complications in children with IBD. Therefore, we aimed to analyze data on preoperative anti-TNF-α and postoperative complications in pediatric IBD.

METHODS

We conducted a systematic literature search in 4 databases for studies that compared the incidence of postoperative complications between children with IBD who received anti-TNF-α treatment within 12 weeks prior to intestinal resection and who did not receive anti-TNF-α before the operation. To analyze this question, pooled odds ratios (ORs) were calculated with 95% confidence intervals (CIs). Odds ratios higher than 1 mean higher complication rate among children treated with preoperative anti-TNF-α, whereas an OR lower than 1 means lower complication rate. The I² value was calculated to measure the strength of the between-study heterogeneity, where a smaller percentage means the lower heterogeneity.

RESULTS

We found 8 eligible articles with 526 pediatric patients with IBD. The primary outcome was the overall complication. The pooled OR of overall complications was 1.38 (95% CI, 0.10-18.76; P = .65; I2 = 34%) in contrast, the OR of infectious and noninfectious complications were 0.59 (95% CI, 0.21-1.69; P = .16; I2 = 0%) and 0.48 (95% CI, 0.18-1.25; p = .09; I2 = 0%), although both showed a nonsignificant result.

CONCLUSION

There is no significant association between preoperative anti-TNF-α therapy and postoperative complications in children with IBD after intestinal resection. However, the evidence is low due to the low number of studies investigating this question.

Timing of individualized surgical intervention in Crohn’s disease

Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide. Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications. Surgical intervention plays a vital role in comprehensive therapy. However, deciding the optimal timing for surgical intervention has long been a focus of controversy. This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.

CHARACTERISTICS OF WOUND INFECTIONS AND METHODS OF THEIR TREATMENT USING PREPARATIONS OF BIOLOGICAL ORIGIN

Surgical wound infections are the most common patients’ complications in the postoperative period. In the modern clinic, they worsen the disease prognosis and remain the most important and acute health problem in all countries of the world. The aim of the work was to analyze current scientific data on the peculiarities of the pathogenesis of wound infections and types of their pathogens, as well as drugs of biological origin in the treatment of wound infections. The paper discusses in detail the problem of infection of wound injuries during surgery and domestic injuries of various kinds. The main pathogens of wound infections are considered. Specific pathogenicity factors for bacteria of the genera Staphylococcus, Pseudomonas, Enterobacteriaceae were analyzed. Based on the analysis of literature sources, a list of drugs of biotechnological origin that can be effectively used in combination therapy for the treatment and prevention of wound infections was determined. Conclusions. The result is the identification of those mechanisms of pathogenesis of wound infections that determine the effectiveness of the use of drugs of biological origin in this pathology treatment.