Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

Table 1 Hypoalbuminemia

Ref.	Year	Studies	Cohort	Results
Nguyen et al[8]	2019	Retrospective (2005-2012)	CD and UC	Moderate to severe hypoalbuminemia is associated with increased post-operative infection: CD 20% vs 13%, P < 0.01; UC 28% vs 15%, P < 0.01. In the case of severe hypoalbuminemia, increased risk of intra-abdominal infection, sepsis, shock and pneumonia; additional risk for urinary tract infection in UC
Huang et al[5]	2015	Meta-analysis: 8 studies for hypoalbuminemia: Cohort; case control; case control; case control; case control; case control; cohort; case control	CD	Hypoalbuminemia is a risk factor for infectious complications
Liu et al[19]	2017	Retrospective 2014-2016	CD	Increased surgical site infection with hypoalbuminemia
Ghoneima et al[4]	2019	Retrospective 2012-2017	CD	Hypoalbuminemia is a predictive risk for septic complications especially if associated with anemia and high CRP
Yang et al[20]	2012	Retrospective 1991-2010	CD	Preoperative albumin < 30 g/L increased the risk of post-operative complication by 2.6 fold

CD: Crohn’s disease; UC: Ulcerative colitis; CRP: C-reactive protein.

Table 2 Malnutrition

Ref.	Year	Cohort	Studies	Results
Maeda et al[9]	2014	CD	Retrospective 2005-2013	Increased surgical site infections
Liu et al[19]	2017	CD	Retrospective 2014-2016	Increased surgical site infection
Yamamoto et al[10]	2019	UC and CD	Case control	Increased infectious complications postoperatively; this becomes significant when associated with biologics

CD: Crohn’s disease; UC: Ulcerative colitis.

Table 3 Preoperative abscess

Ref.	Year	Cohort	Studies	Results
Morar et al[21]	2015	CD	Retrospective; single center	Increased risk of IASC
Huang et al[5]	2015	CD	Meta-analysis 12 studies	Preoperative abscess increases risk of IASCs

CD: Crohn’s disease; IASC: Intra-abdominal septic complications.

Table 4 Obesity

Ref.	Year	Cohort	Studies	Results
Jiang et al[11]	2022	IBD	Systematic review and meta-analysis of 15 retrospective observational studies	Obesity increases post-operative infection, wound infection and surgical site infection

IBD: Inflammatory bowel disease.

Table 5 Perioperative blood transfusion

Ref.	Year	Cohort	Study	Results
Madbouly et al[12]	2006	UC	Retrospective study	Increased overall infection
Lan et al[13]	2018	CD	Retrospective study: 10100 patients, 611 underwent blood transfusion	Increases rate of infection and this was dose-dependent

CD: Crohn’s disease; UC: Ulcerative colitis.

Table 6 Corticosteroids

Ref.	Year	Cohort	Study	Results
Aberra et al[22]	2003	UC and CD; 159 patients	Retrospective 1999-2000	Increased post-operative infection; No increase observed when 6 MCP/AZP were used
Nguyen et al[23]	2014	UC and CD; 15945 patients	Retrospective 2005-2012	Increased post-operative infection
Fumery et al[25] (REMIND group)	2017	CD; 209 patients	Prospective study 2010-2014	Increased overall post-operative complications, intra- and extra-abdominal septic complications
Subramanian et al[24]	2008	UC and CD	Meta-analysis; 7 studies	Increased infectious complications postoperatively and these increase with a dose of > 40 mg/day of corticosteroids
Law et al[14]	2020	UC and CD	Meta-analysis; 35 studies	Increased infectious complications and intra-abdominal infections

CD: Crohn’s disease; UC: Ulcerative colitis; MCP/AZP: Mercaptopurine/azathioprine.

Table 7 Ustekinumab

Ref.	Year	Study	Patient cohort	Last dose taken	Overall results
Garg et al[26]	2021	Meta-analysis 5 retrospective studies; comparison of UST to either VDZ, anti-TNF or no biologics	Crohn disease	16 wk	Relative safety of UST use preoperatively

UST: Ustekinumab; VDZ: Vedolizumab; TNF: Tumor Necrosis Factor.

Table 8 Anti-integrin antibodies

Ref.	Year	Patient cohort	Studies comparing VDZ to either anti-TNF or no biologics	Last dose of VDZ	Overall results
Law et al[27]	2018	IBD: UC and CD	5 studies: UC only, retrospective; Retrospective; Retrospective; Post hoc analysis; Retrospective	Within 16 wk; Within 12 wk; Within 12 wk; N/A; Within 4 wk	No significant increase in post-operative infectious complications when compared to anti-TNF treatment or no biologics
Yung et al[28]	2018	IBD: UC and CD	4 studies: UC only, retrospective; CD only, retrospective; Retrospective; Retrospective	16 wk; 12 wk; 12 wk; 4 wk	No significant differences in infectious complications and SSI were noted in the group VDZ vs anti-TNF or no biologics; the results were similar in UC and CD patients
Guo et al[29]	2021	IBD: UC and CD	12 studies	4-16 wk	Decreased risk of overall post-operative infection complications; however, risk of infection at specific sites-SSI, deep SSI increased

CD: Crohn’s disease; UC: Ulcerative colitis; IBD: Inflammatory bowel disease; SSI: surgical site infection; VDZ: Vedolizumab; TNF: Tumor Necrosis Factor.

Table 9 Anti-tumor necrosis factor therapy

Ref.	Year	Cohort	Studies	Results
Billioud et al[30]	2013	UC an-d CD	Meta-analysis	Slight increase in overall post-operative complications, infectious complications in CD patients in particular
Ahmed Ali et al[31]	2014	CD	Meta-analysis	Increased wound infection and sepsis
Yang et al[33]	2014	CD	Meta-analysis; 10 studies	Modest increase in post-operative infectious complications
Narula et al[32]	2013	UC and CD	Meta-analysis; 15 studies	Modest increase in post-operative infectious complications
Law et al[14]	2020	UC and CD	Systematic review; Cochrane	Increased infectious complications in CD patients when treatment started within 8 wk of surgery
Yang et al[35]	2012	UC	Meta-analysis; 13 studies	No increase in post-operative early complications
Rosenfeld et al[36]	2013	CD	Systematic review and meta-analysis: 6 studies; 1159 patients	No significant difference in major complications noted between infliximab and control groups
Xu et al[34]	2019	CD	Meta-analysis: 14 studies for infectious complications	No increased risk of post-operative infection with preoperative infliximab
Cohen et al[15]	2019	UC and CD	Prospective	No increase in infection or SSI

CD: Crohn’s disease; UC: Ulcerative colitis; SSI: Surgical site infection.

Table 10 Minimally invasive surgery (laparoscopic surgery and robotic surgery) versus open surgery

Ref.	Year	Cohort	Study	Results
Dasari et al[37]	2011	CD	Meta-analysis of 2 RCTs	No differences found in post-operative infectious complications
Lee et al[38]	2012	CD	Retrospective	Decreased sepsis in laparoscopic group
Patel et al[39]	2013	CD	Meta-analysis	Decreased infectious complications in laparoscopic group
Wu et al[40]	2010	UC	Meta-analysis and systematic review	Decreased total complication rate
Lo et al[41]	2021	UC	Retrospective	Decreased sepsis, even in patients on steroids
Hota et al[42]	2021	CD	Retrospective	Decreased anastomotic leaks and wound infections in minimally invasive group

CD: Crohn’s disease; UC: Ulcerative colitis; RCT: Randomized controlled trials.