S1672 Perioperative Management Strategies in Ulcerative Colitis: A Meta-Analysis of Outcomes Category

Introduction: Surgical intervention remains a critical option for patients with ulcerative colitis (UC) who fail medical therapy or develop complications. Optimal perioperative management, including the timing and selection of immunosuppressive agents, significantly influences postoperative outcomes. However, evidence guiding best practices remains fragmented. To evaluate and synthesize current data on perioperative management strategies in UC patients undergoing colorectal surgery, focusing on postoperative complications, infection rates, and surgical outcomes. Methods: A systematic review and meta-analysis were conducted per PRISMA guidelines using R (packages: meta, dmetar). MEDLINE, EMBASE, and Cochrane Library were searched through April 2024 for studies reporting perioperative outcomes in UC patients receiving corticosteroids, biologics, or small molecules preoperatively. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with the I² statistic. Results: A total of 24 studies (N = 6,212 patients) were included. Preoperative corticosteroid use was associated with an increased risk of infectious complications (OR 1.72, 95% CI 1.36–2.18) and delayed wound healing. Anti-TNF agents (e.g., infliximab) showed a modest but significant increase in surgical site infections (OR 1.34, 95% CI 1.01–1.77), whereas vedolizumab demonstrated a neutral impact (OR 1.05, 95% CI 0.81–1.36). JAK inhibitors had limited data but suggested a non-significant trend toward higher complication rates. Early post-op initiation of biologics did not increase risk when compared to delayed use. Sensitivity analyses confirmed robustness of findings, and publication bias was minimal. Conclusion: Perioperative use of corticosteroids and some biologics is associated with increased risk of postoperative complications in UC surgery. Vedolizumab appears to offer a safer perioperative profile, while early biologic re-initiation post-surgery may be feasible. These findings support stratified perioperative management to minimize surgical morbidity in UC and highlight areas for future prospective trials.