ADVANCED therapies for inflammatory bowel disease (IBD) were not consistently associated with increased postoperative complications, although some associations were observed with anti-tumour necrosis factor (anti-TNF) treatment, according to a systematic review and meta-analysis.
Study Assessed Advanced Therapies and Surgery
The researchers conducted a cross-class systematic review of studies involving patients with IBD undergoing abdominal surgery. Five databases were searched through May 2026, with 94 publications ultimately included in the analysis.
Random-effects meta-analyses compared patients exposed to advanced therapies before surgery with unexposed patients across 13 pre-specified postoperative outcomes. The researchers separately pooled confounding-adjusted estimates, compared these with crude estimates and assessed the quality of the evidence using GRADE.
Anti-TNF Signals Were Inconsistent
The analysis found no uniform excess of postoperative complications associated with advanced therapies. An isolated association with deep vein thrombosis was identified, with an odds ratio (OR) of 2.62, but the researchers considered disease-severity confounding the most plausible explanation.
Crude anti-TNF exposure was associated with overall complications (OR: 1.14; 95% CI: 1.02–1.28) and intra-abdominal abscess (OR: 1.18; 95% CI: 1.01–1.39). The abscess association was also observed in higher-quality evidence (OR: 1.34). Infliximab exposure was associated with sepsis (OR: 2.38; 95% CI: 1.30–4.38).
However, infectious complications, surgical site infection and anastomotic leak were not significantly associated with anti-TNF exposure. The observed signals were confined to Crohn’s disease.
After adjustment for confounding, anti-TNF exposure remained associated with overall complications (OR: 1.53; 95% CI: 1.12–2.08; k=18) and infectious complications (OR: 1.51; 95% CI: 1.18–1.92). These findings were heterogeneous and became non-significant with the deepest level of adjustment.
Findings Do Not Support Routine Discontinuation
The study that confirmed treatment exposure using measured serum drug levels rather than a preoperative calendar window found no association between anti-TNF therapy and infection (OR: 1.05). Vedolizumab was not associated with increased complications, although higher readmission and reoperation rates were observed, which the researchers considered consistent with channelling bias.
Overall, the researchers rated the evidence as very low certainty. Although some postoperative complication signals were identified, they were small and heterogeneous and were absent in drug-level-confirmed evidence.
The findings therefore did not provide robust evidence of independent harm from advanced therapies and did not support routinely discontinuing treatment before surgery or delaying necessary surgery.
Reference
Quraishi MN et al. Postoperative complications associated with advanced therapies in inflammatory bowel disease: a systematic review and meta-analysis. Adv Ther. 2026;DOI:10.1007/s12325-026-03748-4.
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