Supplementary Material for: Systematic review and meta-analysis: Association between preoperative ustekinumab and surgical complications in Crohn's disease patients

Introduction: The impact of ustekinumab (UST) therapy on surgical complications in patients with Crohn's disease (CD) remains controversial. The aim of this meta-analysis is to explore the link between these two. Methods: Databases (PubMed, Web of Science, Cochrane, and Springer Link) were searched until April 2022. Studies of CD patients who received UST and no UST prior to surgery (including no biological therapy, anti-TNF-α agent, and VDZ) were included. Primary outcomes included overall complications, infectious complications, and non-infectious complications. Results: Nine studies totaling 3,225 CD patients were enrolled; 332 patients received UST treatment. There was no evidence of difference in the overall complications (OR=0.84, p=0.37, 95%CI=[0.57-1.23], I2=40%) between CD patients who had UST treatment preoperatively and those who had no UST treatment. There was no evidence of a difference in infectious complications (OR=1.15, p=0.35, 95%CI=[0.86-1.53], I2=2%). Additionally, there was no significant no evidence of difference between these group in terms of non-infectious complications and death. Specifically, there were no evidence of difference in overall complications, infection complications (including wound complications, sepsis, abscess and anastomotic leakage), and non-infection complications (ileus, readmission, and return to operation), compared with no biological therapy and anti-TNF-α agents. At the same time, no significant evidence of difference was discovered in the comparison of preoperative UST and VDZ therapy in terms of overall complications, infectious complications (sepsis and abscess), and non infectious complications (intestinal obstruction, readmission, and recovery surgery). Conclusion: In general, compared with other biological agents, preoperative use of UST in the treatment of CD patients is usually safe and does not increase surgical complications.

引言：乌司奴单抗（ustekinumab, UST）疗法对克罗恩病（Crohn's disease, CD）患者手术并发症的影响尚存争议。本项荟萃分析旨在探讨二者之间的关联。
方法：检索截至2022年4月的PubMed、Web of Science、Cochrane及Springer Link数据库。纳入手术前接受乌司奴单抗治疗与未接受乌司奴单抗治疗（包括未接受生物治疗、抗TNF-α制剂及VDZ）的克罗恩病患者相关研究。主要结局指标包括总体并发症、感染性并发症及非感染性并发症。
结果：共纳入9项研究，涉及3225例克罗恩病患者，其中332例接受了乌司奴单抗治疗。术前接受乌司奴单抗治疗的患者与未接受该治疗的患者相比，总体并发症发生率无显著差异（比值比OR=0.84，P=0.37，95%置信区间CI=[0.57-1.23]，I²=40%）。感染性并发症发生率亦无显著差异（OR=1.15，P=0.35，95%CI=[0.86-1.53]，I²=2%）。此外，两组在非感染性并发症与死亡率方面均无显著差异。具体而言，与未接受生物治疗及抗TNF-α制剂的患者相比，术前使用乌司奴单抗的患者在总体并发症、感染性并发症（包括切口并发症、脓毒症、脓肿及吻合口漏）以及非感染性并发症（肠梗阻、再入院及再次手术）方面均无显著差异。同时，对比术前接受乌司奴单抗与VDZ治疗的患者，二者在总体并发症、感染性并发症（脓毒症及脓肿）以及非感染性并发症（肠梗阻、再入院及修复手术）方面均未发现显著差异。
结论：总体而言，相较于其他生物制剂，克罗恩病患者术前接受乌司奴单抗治疗通常具有安全性，并不会增加手术并发症风险。