Biological treatment and the potential risk of adverse postoperative outcome in patients with inflammatory bowel disease: An open source expert panel review of the current literature and future perspectives

There is widespread concern that treatment with biologics agents may be associated with sub-optimal postoperative outcome after surgery for inflammatory bowel diseases (IBD).We aimed to search and analyse the literature regarding the potential association of biologic treatment on adverse postoperative outcome in patients with IBD. We used the subject as a case in point for surgical research. The aim was not to conduct a new systematic review.This is an updated narrative review written in a collaborative method by authors invited through Twitter via the following hashtags (OpenSourceResearch and SoMe4Surgery). The manuscript was presented as slides on Twitter to allow discussion of each section of the paper sequentially. A Google document was created which was shared across social media and comments and edits were verified by the primary author to ensure accuracy and consistency.Forty-one collaborators responded to the invitation, and a total of 106 studies were identified that investigated the potential association of pre-operative biological treatment on postoperative outcome in patients with IBD. Most of these studies were retrospective observational cohorts, 3 were prospective, 4 experimental and 3 population-based studies. These studies were previously analyzed in 10 systematic/narrative reviews and 14 meta-analyses. Type of biologic agents, dose, drug concentration, anti-drug antibodies, interval between last dose and types of surgery varied widely among the studies. Adjustment for confounders and bias control ranged from good to very poor. Only 10 studies reported postoperative outcome according to Clavien-Dindo classification.Although a large number of studies investigated the potential effect of biological treatment on postoperative outcomes, many reported divergent results. There is a need for randomized controlled trials. Future studies should focus on the avoiding the weakness of prior studies we identified. Seeking collaborators and sharing information via Twitter was integral to widening the contributors/authors and peer review for this paper, and was an effective method of collaboration.