# Comparative Risk of Complications Following Intestinal Surgery After Infliximab, Vedolizumab, or Ustekinumab Treatment: Systematic Review & Meta-Analysis

## TL;DR

This study compares the safety of three IBD treatments during intestinal surgery, finding that Ustekinumab has the best safety profile.

## Contribution

The study provides a meta-analysis comparing complication risks after surgery for patients on different IBD biologics.

## Key findings

- Ustekinumab was associated with a lower risk of surgical site infections compared to controls.
- Vedolizumab showed a higher risk of postoperative ileus compared to Infliximab.
- Infliximab did not significantly increase overall postoperative complications compared to controls.

## Abstract

Background: Treatment of inflammatory bowel diseases with biological therapies has significantly increased, with ever increasing numbers of patients receiving such treatment at the time of surgery. This study evaluates the perioperative safety of three commonly used biologics—Infliximab, Vedolizumab, or Ustekinumab—in patients undergoing intestinal surgery for IBDs. Materials and Methods: In this systematic review a comprehensive search was conducted in Scopus, Medline and PubMed up to January 2025 by two independent reviewers, and a total of 34 articles (retrospective studies in the majority of them) reporting total surgical complications of patients treated with these three agents, in comparison to a control group, were included. Relative risks were aggregated using the Mantel-Haenszel method, and the I2 statistic was used to assess between-study heterogeneity. Subgroup analyses were conducted for particular complications, and direct comparisons among the biological agents were made. Results: In the primary analysis, INFL was not linked to a statistically significant rise in overall postoperative complications when compared to controls (RR = 1.13, 95% CI: 0.90–1.42, p = 0.31). VDLZ exhibited a non-significant inclination towards increased complications (RR = 1.26, 95% CI: 0.94–1.67, p = 0.12), although it was linked to a notably higher risk of postoperative ileus compared to INFL (RR = 2.29, 95% CI: 1.59–3.29, p < 0.00001). USTK also did not show significant differences from controls overall (RR = 0.55, 95% CI: 0.20–1.57, p = 0.26), though it was associated with a considerably lower risk of SSIs (RR = 0.35, 95% CI: 0.17–0.73, p = 0.005). There were no significant distinctions between the biological agents regarding SSIs or anastomotic leakage, although many comparisons faced challenges due to high heterogeneity and low event rates. Conclusions: USTK demonstrated the most favorable safety profile, while VDLZ was associated with higher rates of ileus and inflammatory complications. However, prospective studies are warranted.