Issue 11

Clinical Question

What is the post-operative mortality rate in patients undergoing intestinal resection with either Crohn’s disease (CD) or ulcerative colitis (UC)?

Editor’s Bottom Line

Following intestinal resection post-operative mortality is high in emergent (approximately 5%) but not elective (approximately 0.6%) surgery.

Reference

Singh S, Al-Darmaki A, Frolkis AD, et al. Postoperative mortality among patients with inflammatory bowel diseases: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2015 Oct;149(4):928–37. https://www.ncbi.nlm.nih.gov/pubmed/26055136

Synopsis

Study inclusion criteria were population-based studies (published articles or conference presentations from 1990 to 2015) mentioning post-operative mortality rates for either CD or UC, separately. Primary outcomes were mortalities attributed to emergent vs. elective surgeries, geographic regions, and over time (1990–2014).

The 21 studies represented 75,971 CD and 67,057 UC patients from 15 countries. Post-operative mortalities following intestinal resection were significantly lower for elective vs. emergent surgeries for both CD and UC (0.6% and 0.7% vs. 5.3% and 3.6%, respectively; P<0.05 for both). For CD, a significant decrease in post-operative mortalities was identified in studies published prior to 2000 (3.0%) compared to those from 2000 onwards (1.2%; P<0.0001). For UC, there was no difference identified. Comparing studies reporting on cohorts in Europe and North America, no differences in mortality rates were identified.

Details

Study Design: Systematic review and meta-analysis
Funding: Canadian Institutes of Health Research (CIHR), Alberta Innovates-Health Solutions (AIHS), and the Alberta IBD Consortium
Allocation: n/a
Setting: n/a
Level of Evidence: 1a (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.