Comparative risk of postoperative complications in ulcerative colitis patients following preoperative advanced therapies: a network meta-analysis with meta-regression
In brief
Ustekinumab reduces 30-day postoperative complications by roughly 70% in ulcerative colitis
In a network meta-analysis of 16 retrospective cohorts (3,235 UC patients), pre-operative ustekinumab cut overall 30-day surgical complications to about one-third of the rate seen with no biologic, while tofacitinib also lowered risk modestly. Anti-TNF agents were linked to higher complication rates, and venous thromboembolism rates were similar across drugs. Longer-term (90-day) findings are limited, so prospective trials are needed to confirm safety.
- Journal
- Journal of Crohn's & colitis (Q1)
- Published
- 5 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Mohammad Al Hayek, Maria Manuela Estevinho, Maia Kayal, Osamah Al Hayek, Alessandro Armuzzi, Johan Burisch, et al.
- PMID
- 42570330
- DOI
- 10.1093/ecco-jcc/jjag111
Why clinicians should know about it
- Picked for Surgery (paper of the day, 9 August 2026): Network meta-analysis, biologic vs anti‑TNF postoperative complications in UC surgery
Abstract
BACKGROUND: The expanding use of biologic and small-molecule therapies for ulcerative colitis (UC) has raised concerns regarding perioperative safety. We conducted a network meta-analysis to compare short-term postoperative complications associated with preoperative exposure to these agents in patients undergoing colorectal surgery. METHODS: We systematically searched PubMed, Web of Science, and the Cochrane Library through September 15, 2025, for cohort studies of adults with UC who were exposed to biologic or small-molecule therapy within 12 weeks prior to surgery. Interventions included biologic therapy, small-molecule therapy, and no biologic or small-molecule therapy (control). The primary outcome was overall postoperative complications at 30 and 90 days. Venous thromboembolism (VTE) was assessed as a key secondary outcome. Random-effects network meta-analysis was performed using risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: Sixteen retrospective cohort studies involving 3235 patients were included. At 30 days, ustekinumab and tofacitinib were associated with lower overall postoperative complication rates than control (RR: 0.29; 95% CI: 0.09-0.96; and RR: 0.66; 95% CI: 0.46-0.96, respectively). Anti-tumor necrosis factor (TNF) therapy was associated with higher complication rates compared with vedolizumab, ustekinumab, and tofacitinib at 30 days (RR: 1.27; 95% CI: 1.00-1.63; RR: 3.67; 95% CI: 1.12-12.03; and RR: 1.61; 95% CI: 1.14-2.27, respectively). At 90 days, anti-TNF therapy was associated with higher complication rates than control (RR 1.20, 95% CI 1.03-1.40), although the 90-day analysis was based on limited data. VTE rates were similar across treatments at both time points. CONCLUSION: Preoperative ustekinumab and tofacitinib were associated with fewer 30-day postoperative complications than control or anti-TNF therapy, while vedolizumab was associated with fewer complications than anti-TNF therapy. At 90 days, anti-TNF therapy was associated with higher complication rates compared with control. These findings, particularly at 90 days based on limited data, should be interpreted with caution and require confirmation in well-designed prospective studies with rigorous adjustment for confounding factors.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.