The Impact of Pre-Operative Biologic Therapy on Post-Operative Surgical Outcomes in Ulcerative Colitis – A Systematic Review and Meta-Analysis


Jasmine Zanelli
Warwick Medical School, University of Warwick
Subashini Chandrapalan
Warwick Medical School, University of Warwick
Abhilasha Patel
Warwick Medical School, University of Warwick
Ramesh Arasaradnam
Warwick Medical School, University of Warwick



Biologic therapy has emerged as an effective modality amongst the medical treatment options available for ulcerative colitis (UC). However, its impact on post-operative care in patients with UC is still up for debate.


This review attempted to evaluate the risk of having post-operative complications following biologic therapy in patients with UC.


A systematic search of the relevant databases was conducted with the aim of identifying studies which compared the post-operative complication rates of UC patients, who were either exposed or not exposed to a biologic therapy, prior to their surgery. Outcomes of interest included both the infectious and the total complication rates. Pooled odds-ratios and 95% confidence intervals were calculated.


19 studies, reviewing a total of 12,308 patients with UC, were included in the meta-analysis. 2199 of those had had an exposure to a biologic therapy prior to surgery. The pooled OR for the infectious complications and the total complications were 0.95 (95% CI 0.62-1.45) and 1.14 (95% CI 1.04-1.28) respectively, which suggests that there was no significant association between the pre-operative biologic therapy and post-operative infectious or total complications. Moreover, the duration between the last dose of biologic therapy and surgery did not influence the risk of having a post-operative infection.

Key Messages

This meta-analysis suggests that the pre-operative biologic therapy does not increase the overall risk of having a post-operative infection or any complication. Being on biologic therapy should not delay an abdominal surgery in patients with ulcerative colitis.

December 30, 2020