医学
炎症性肠病
围手术期
系统回顾
科克伦图书馆
重症监护医学
不利影响
结直肠外科
疾病
托法替尼
英夫利昔单抗
外科
结肠切除术
梅德林
内科学
腹部外科
随机对照试验
溃疡性结肠炎
类风湿性关节炎
政治学
法学
作者
Eunah Lee,J. Alexander Sizemore,Grace J. Kim,Bo Shen,Bruce E. Sands
出处
期刊:Diseases of The Colon & Rectum
[Ovid Technologies (Wolters Kluwer)]
日期:2024-01-31
标识
DOI:10.1097/dcr.0000000000003222
摘要
Patients with inflammatory bowel disease may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. The question of the impact of biologic use on postoperative complications is a topic of active investigation.A systematic literature review was performed to describe the current state of knowledge of the impact of perioperative biologic and tofacitinib use on postoperative complications in patients with inflammatory bowel disease.PubMed and Cochrane databases were searched.Studies between January 2000 and January 2023, in any language, were searched, followed by a snowball search identifying further studies, in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Articles regarding pediatric or endoscopic management were excluded.Preoperative or perioperative exposure to biologics in inflammatory bowel disease was included.Infectious and noninfectious complications, including anastomotic leaks, surgical site infections, urinary tract infections, pneumonia, sepsis, septic shock, postoperative length of stay, readmission, and reoperation, were the main outcomes measured.A total of 28 studies were included for analysis in this review, including 7 meta-analyses or systematic reviews, and 5 randomized studies. Snowball search identified 11 additional studies providing topical information. Overall, tumor necrosis factor inhibitors likely do not increase risk of postoperative adverse outcomes, while data on other biologics and small molecule agents are emerging.This is a qualitative review including all study types. The varied nature of study types precludes quantitative comparison.Although steroids increase postoperative infectious and noninfectious complications, tumor necrosis factor inhibitors do not appear to increase postoperative infectious and non-infectious complications. There is a need for further perioperative data for other agents. See Video.
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