Plain language summary Infection risk after surgery in patients using medications for inflammatory bowel disease Background More than 1.2 million individuals in North America are affected by inflammatory bowel disease (IBD). It is a condition that involves inflammation in the large and/or small intestine(s), resulting in symptoms such as diarrhea and abdominal pain. Many of the medications used to treat IBD suppress the immune system. As a result, use of these medications increases the risk of infection. This increased risk of infection is particularly concerning in patients undergoing surgery. Review Question This systematic review examined the combined data from 68 previously published studies to determine whether patients using IBD medications around the time of surgery had more infections compared to those not using the same medications. Study Characteristics This systematic review is current up to 29 October 2019. It included 68 studies in patients with IBD who underwent surgery. Most participants were 18 years or older and both men and women were included. Five IBD medication groups were examined within our study. Infections were tracked up to 30 days after surgery. Key Results Analyses of this large set of data revealed that infection risk around the time of surgery varied depending on which type of IBD medication the patients were on. Patients being treated with corticosteroids or anti‐TNF agents seemed to have more infections after surgery, while those on 5‐ASA, immunomodulators or anti‐integrin agents did not seem to have more infections after surgery. These findings should be taken with caution as our review included studies which were of limited quality, and therefore we were not able to draw any firm conclusions. These findings could help doctors choose which medications to treat IBD patients with before surgery. Decisions should be tailored to each patient’s unique health needs. In addition, this study suggests the need to carefully monitor for infections after surgery in patients who are on certain types of IBD medications. Limitations One limitation of this systematic review was its dependence on data from a wide range of previously published studies, with various approaches and quality control standards. Most studies examined had very low certainty regarding its conclusions. This review illustrates the need for future high‐quality research examining the impact of medications used to treat IBD on infection risk after surgery.
【저자키워드】 Adult, Adrenal cortex hormones, bias, Crohn disease, infections, humans, Integrins, male, female, Immunologic factors, inflammatory bowel diseases, Odds ratio, Surgical Wound Infection, Postoperative Complications, Time factors, Confidence intervals, tumor necrosis factor-alpha, Colitis, ulcerative, Adrenal Cortex Hormones/adverse effects, Aminosalicylic Acids, Aminosalicylic Acids/adverse effects, Colitis, Ulcerative/drug therapy, Crohn Disease/drug therapy, Immunologic Factors/adverse effects, Infections/chemically induced, Infections/epidemiology, Inflammatory Bowel Diseases/drug therapy, Observational Studies as Topic, Postoperative Complications/chemically induced, Postoperative Complications/epidemiology, Surgical Wound Dehiscence, Surgical Wound Dehiscence/chemically induced, Surgical Wound Dehiscence/epidemiology, Surgical Wound Infection/chemically induced, Surgical Wound Infection/epidemiology,