OBJECTIVES: In addition to the pharmacological efficacy of infliximab therapy in inflammatory bowel disease (IBD), it is also important to evaluate its impact on other health outcomes, particularly in the rate of surgical interventions and hospitalizations, which have high economic burden and are believed to represent a marker of IBD severity. We aimed to estimate the impact of infliximab in these outcomes in patients with IBD. METHODS: Systematic review and meta-analysis of experimental (clinical trials) and observational studies comparing infliximab with any other control group in IBD. Studies were identified by searching Medline and Cochrane from inception to April 2012. Search results and studies characteristics were assessed independently. Subgroup analyses were done according to IBD type: Crohn disease (CD) and ulcerative colitis (UC). Pooled estimates were performed separately for clinical trials and observational studies. Odds ratios (OR) and 95% confidence intervals (CI) were derived by random-effects meta-analysis. Heterogeneity was assessed with I2 test. RESULTS: Nine trials and 9 observational studies were included. Infliximab significantly decreased risk of gastrointestinal surgery in experimental studies (OR 0.36; 95%CI: 0.18-0.71), both in DC (OR 0.25; 95%CI: 0.10-0.63) and UC (OR 0:55; 95%CI: 0.40-0.76). In absolute terms, there was a 9% reduction in the rate of surgery (95%CI: 1-19%). Observational studies also showed a reduced risk of surgery, which was significant in the case of CD (OR 0.42; 95% CI: 0.22 to 0.78). Infliximab significantly reduced the risk of hospitalization, both in experimental (OR 0.48; 95%CI: 0.34-0.66) and observational (OR 0:38; 95%CI: 0.24-0.58) studies, with a decrease of 9% in hospitalization rate (95%CI: 5-14%). Mean duration of hospitalization was shorten by 4.2 days (95%CI: 1.9-6.5) in infliximab treated patients. CONCLUSIONS: Based on the best available evidence, infliximab therapy is associated with a reduced risk of gastrointestinal surgery and hospitalization rates in patients with IBD.