Impact of smoking on the surgical outcome of Crohn's disease: a propensity‐score matched National Surgical Quality Improvement Program analysis

Kulaylat, Afif N.; Hollenbeak, C.; Sangster, William; Stewart, David B.

doi:10.1111/codi.12958

Cited by 19 publications

(9 citation statements)

References 30 publications

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“…Smoking is known to complicate both the surgical and the medical management of CD, and to increase both the rate and the severity of infectious complications following colorectal surgery. [20][21][22] Work by Midura et al showed smoking status to be an independent predictor of anastomotic leak.…”

Section: Discussionmentioning

confidence: 99%

African Americans and Short-Term Outcomes after Surgery for Crohn’s Disease: An ACS-NSQIP Analysis

Arsoniadis

Melton

et al. 2016

ECCOJC

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Background: Previous reports on racial disparities in the treatment of Crohn's disease [CD] [smoking], race remained a statistically significant factor in postoperative complication rate. Only after additional adjustment was made for comorbidities and American Society of Anesthesiologists class did race lose significance within our model. Conclusion: African Americans experience a greater amount of postoperative complications following surgery for Crohn's disease. Preoperative disease management, addressing smoking status and control of comorbid disease are important factors in addressing the racial disparities in the surgical treatment of Crohn's disease.

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Section: Discussionmentioning

confidence: 99%

African Americans and Short-Term Outcomes after Surgery for Crohn’s Disease: An ACS-NSQIP Analysis

Arsoniadis

Melton

et al. 2016

ECCOJC

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“…The majority of studies examining readmission risk in IBD have either been single-center studies or have focused on surgical patients [ 10 , 11 ]. As such, understanding risk factors such as patient specific comorbidities, socioeconomic factors and hospitalization factors leading to readmissions among a large IBD cohort could allow for guided quality improvement interventions aimed at decreasing readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease

et al. 2017

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BackgroundManagement of inpatients with inflammatory bowel disease (IBD) requires increasing resources. We aimed to identify factors associated with hospital readmissions among individuals with IBD.Materials & methodsWe collected data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database 2013. We identified individuals with index hospitalizations for IBD. Patient-specific factors, comorbidities and hospitalization characteristics were extracted for the index hospitalization. We performed logistic regression modeling to create adjusted odds ratios (ORs) for 30-day hospital readmission. Subgroup analysis was performed based on disease type and performance of surgery.ResultsWe analyzed a total of 55,942 index hospital discharges; 3037 patients (7.0%) were readmitted to the hospital within 30 days. Increasing patient age (> 65: OR: 0.45; 95% CI 0.39–0.53) was associated with a decreased risk of readmission, while a diagnosis of Crohn’s disease (OR: 1.09; 95% CI 1.00–1.18) and male sex (OR: 1.16; 95% CI 1.07–1.25) were associated with an increased risk of readmission. The comorbidities of smoking (OR: 1.09; 95% CI 1.00–1.19), anxiety (OR: 1.17; 95% CI 1.01–1.36) and opioid dependence (OR: 1.40; 95% CI 1.06–1.86) were associated with an increased risk of 30-day readmission. Individual hospitalization characteristics and disease complications were significantly associated with readmission. Performance of a surgery during the index admission was associated with a decreased risk of readmission (OR: 0.57; 95% CI 0.33–0.96).ConclusionAnalyzing data from a US publicly available all-payer inpatient healthcare database, we identified patient and hospitalization risk factors associated with 30-day readmission. Identifying patients at high risk for readmission may allow for interventions during or after the index hospitalization to decrease this risk.

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“…We have performed MVA with subgroup analyses which demonstrate similar trends. However, some variables have not been adjusted for and need to be considered when interpreting our results: smoking status, which is known to be associated with postoperative morbidity, 40 was not included in the analysis due to inconsistent reporting; we also did not collect data regarding comorbidities or operating time which have been associated with worse outcomes 4,41 . Nevertheless, the median age in the ITT and non‐optimised cohorts was <45 years where the likelihood of multimorbidity is low 42 .…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study: pre‐operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD centre

Meade

Patel

Luber

et al. 2022

Aliment Pharmacol Ther

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Summary Background Low‐quality evidence suggests that pre‐operative exclusive enteral nutrition (E/EN) can improve postoperative outcomes in patients with Crohn's disease (CD). It is not standard practice in most centres. Aims To test the hypothesis that pre‐operative EN in patients undergoing ileal/ileocolonic surgery for CD is associated with improved postoperative outcome. Methods We performed a single centre retrospective observational study comparing surgical outcomes in patients receiving pre‐operative EN (≥600 kcal/day for ≥2 weeks) with those who received no nutritional optimisation. Consecutive adult patients undergoing ileal/ileocolonic resection from 2008 to 2020 were included. The primary outcome was postoperative complications <30 days. Secondary outcomes included EN tolerance, specific surgical complications, unplanned stoma formation, length of stay, length of bowel resected, readmission and biochemical/anthropometric changes. Results 300 surgeries were included comprising 96 without nutritional optimisation and 204 optimised cases: oral EN n = 173, additional PN n = 31 (4 of whom had received nasogastric/nasojejunal EN). 142/204 (69.6%) tolerated EN. 125/204 (61.3%) initiated EN in clinic. Patients in the optimised cohort were younger at operation and diagnosis, with an increased frequency of penetrating disease and exposure to antibiotics or biologics, and were more likely to undergo laparoscopic surgery. The optimised cohort had favourable outcomes on multivariate analysis: all complications [OR 0.29; 0.15–0.57, p < 0.001], surgical complications [OR 0.41; 95% CI 0.20–0.87, p = 0.02], non‐surgical complications [OR 0.24 95% CI 0.11–0.52, p < 0.001], infective complications [OR 0.32; 95% CI 0.16–0.66, p = 0.001]. Conclusions Oral EN was reasonably well tolerated and associated with a reduction in 30‐day postoperative complications. Randomised controlled trials are required to confirm these findings.

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Impact of smoking on the surgical outcome of Crohn's disease: a propensity‐score matched National Surgical Quality Improvement Program analysis

Abstract: In patients with CD, the detrimental effects of smoking on surgical outcomes are driven by infectious and pulmonary complications, and by an increased likelihood of readmission.

Cited by 19 publications

References 30 publications

African Americans and Short-Term Outcomes after Surgery for Crohn’s Disease: An ACS-NSQIP Analysis

African Americans and Short-Term Outcomes after Surgery for Crohn’s Disease: An ACS-NSQIP Analysis

Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease

A retrospective cohort study: pre‐operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD centre

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