Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2023; 15(11): 2579-2595
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2579
Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review
Reshma Kureemun Mowlah, Jonathan Soldera
Reshma Kureemun Mowlah, Jonathan Soldera, Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: Mowlah RK and Soldera J participated in the concept and design of the research, drafted the manuscript and contributed to data acquisition, analysis and interpretation; Soldera J contributed to study supervision; all authors contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Tutor, Acute Medicine, University of South Wales, Llantwit Road, Pontypridd, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: July 17, 2023
Peer-review started: July 17, 2023
First decision: August 8, 2023
Revised: August 13, 2023
Accepted: October 27, 2023
Article in press: October 27, 2023
Published online: November 27, 2023
Abstract
BACKGROUND

Indications for surgery in inflammatory bowel disease (IBD) include treatment-refractory disease or severe complications such as obstruction, severe colitis, dysplasia, or neoplasia. Infectious complications following colorectal surgery in IBD are significant, particularly in high-risk patients.

AIM

To gather evidence on risk factors associated with increased post-operative infectious complications in IBD and explore management strategies to reduce morbidity and mortality.

METHODS

A systematic review adhering to PRISMA-P guidelines was conducted. MEDLINE (PubMed) and Cochrane Library databases were searched using specific keywords. Inclusion criteria encompassed studies involving patients with IBD undergoing abdominal surgery with infectious complications within 30 d postoperatively. Exclusion criteria included patients under 18 years and non-infectious complications. Selected papers were analyzed to identify factors contributing to post-operative infections. A narrative analysis was performed to provide evidence-based recommendations for management. The data were then extracted and assessed based on the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

The initial database search yielded 1800 articles, with 330 articles undergoing full-text review. After excluding duplicates and irrelevant papers, 35 articles were included for analysis. Risk factors for post-operative complications in patients with IBD included hypoalbuminemia, malnutrition, preoperative abscess, and obesity. Perioperative blood transfusion was associated with increased infectious complications. Medications such as 5-aminosalicylates and immunomodulators did not increase post-operative complications. Corticosteroids were associated with an increased risk of complications. Ustekinumab and vedolizumab showed similar rates of infectious complications compared to other treatments. The impact of minimally invasive surgery on post-operative complications varied across studies.

CONCLUSION

In order to reduce post-operative infectious complications in patients with IBD, a comprehensive approach involving multiple disciplines is necessary.

Keywords: Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Peri-operative infections, Infliximab.

Core Tip: This paper highlights the risk factors associated with post-operative infectious complications in patients with inflammatory bowel disease (IBD) undergoing abdominal surgery and explores management strategies to reduce morbidity and mortality. Key findings include the association of hypoalbuminemia, malnutrition, preoperative abscess, obesity, and perioperative blood transfusion with increased infectious complications. Corticosteroids were found to be a risk factor, while medications such as 5-aminosalicylates and immunomodulators did not increase complications. Ustekinumab and vedolizumab showed comparable rates of infectious complications to other treatments. The impact of minimally invasive surgery on complications varied. This paper emphasizes the importance of a comprehensive approach involving multiple disciplines to mitigate post-operative infections in IBD patients. Understanding these risk factors and implementing appropriate management strategies can improve outcomes in this patient population.