Issue 11

Clinical Question

Do elderly patients with IBD have similar postoperative mortality and complication rates as their younger counterparts undergoing IBD-related surgeries?

Editor’s Bottom Line

IBD surgery in the IBD patient over 65 years of age has significantly higher mortality and postoperative complication rates compared to similar surgery in a younger age group.

Reference

Bollegala N, Jackson TD, Nguyen GC. Increased postoperative mortality and complications among elderly patients with inflammatory bowel diseases: an analysis of the National Surgical Quality Improvement Program cohort. Clin Gastroenterol Hepatol. 2016 Sep;14(9):1274–81. https://www.ncbi.nlm.nih.gov/pubmed/26656299

Synopsis

The American College of Surgeons National Surgical Quality Improvement Program database was searched between 2005–2012 for individuals undergoing IBD-related surgeries. The primary outcome variable was death within 30 days of surgery or postoperative complications. Secondary postoperative outcomes were also recorded as well as length of hospitalization. Between 2011 and 2012, data collection was more comprehensive and included items such as 30-day planned and unplanned re-operations. Patients were then categorized as either elderly (≥65 years) or non-elderly (<65 years).

A total of 15,495 patients were identified of which 736 and 917 were elderly with Crohn’s disease (CD) and ulcerative colitis (UC), respectively. Elderly postoperative mortality rates were higher for both CD and UC when compared to younger patients (CD: 4.2% vs. 0.3%; UC: 6.1% vs. 0.7%; P<0.001 for both). Similarly, postoperative complications in the elderly were nearly double the rates for younger IBD patients. In particular, elderly UC patients were at increased risk for infectious complications (adjusted OR 1.52), while elderly CD patients had a higher risk of postoperative venous thromboembolism (adjusted OR 1.68). Twice as many elderly patients were in hospital more than 30 days after surgery compared to younger IBD patients (5.0% vs. 1.8%, P<0.001).

Details

Study Design: Retrospective observational study
Funding: n/a
Allocation: n/a
Setting: National database
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.