Postoperative Complications After Lumbar Spinal Surgery in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Objective: Patients with inflammatory bowel disease (IBD) may be at increased risk of complications following lumbar spine surgery due to systemic inflammation, immunosuppressive therapy and nutritional deficiencies. This systematic review and meta-analysis evaluated the comparative outcomes of lumbar spinal surgery in patients with and without IBD. Methods: We searched five databases through June 2025 for randomized and observational studies comparing postoperative outcomes of lumbar spine surgery of any type between adult patients with and without IBD. A random-effects meta-analysis was performed using the DerSimonian and Laird method. Results: Four retrospective cohort studies encompassing 878,116 patients (15,763 with IBD and 564,733 controls) were included. IBD patients had significantly higher odds of multiple adverse outcomes, including any complication (OR = 1.63, 95% CI: 1.08–2.47), serious adverse events (OR = 1.68, 95% CI: 1.39–2.02), minor adverse events (OR = 2.04, 95% CI: 1.63–2.55), wound infections (OR = 1.21, 95% CI: 1.08–1.35), venous thromboembolic events (OR = 1.86, 95% CI: 1.49–2.32), pneumonia (OR = 2.31, 95% CI: 1.93–2.77), urinary tract infections (OR = 2.29, 95% CI: 1.35–3.87), acute kidney injury (OR = 1.91, 95% CI: 1.68–2.17) and blood transfusions (OR = 1.64, 95% CI: 1.29–2.08). Myocardial infarction (OR = 1.76, 95% CI: 1.40–2.23) was also more common in IBD patients. No significant difference was observed in 90-day hospital readmissions. Conclusion: Patients with IBD may experience significantly increased risks of postoperative complications after lumbar spine surgery. However, substantial heterogeneity among retrospective studies limits the strength of causal inferences. These findings highlight the importance of tailored perioperative management and risk counseling in this population.