Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics

Abstract

Although nonelective IBD surgery rates have remained stable, associated 30-day mortality for UC has doubled in recent years despite advances in medical management. Current clinical decision-making and care pathways must be further evaluated to improve outcomes in this high-risk population.

Editorial: post‐operative complications in elderly onset inflammatory bowel disease—what is surgery, what is disease, and what is delay of surgery?

“…Fourteen per cent of all operated patients had complications requiring surgical, endoscopic and/or radiological intervention and five (4%) patients eventually died . Emergency surgery increased the risk of early post‐operative complications, odds ratio 4.46 (95% confidence interval 1.75‐11.36), and similar findings regarding emergency surgery has been shown previoulsy . An English study on emergency colorectal surgery found the 30‐day mortality risk to be four‐times greater compared with scheduled procedures .…”

“…In Denmark the total 30‐day mortality was 1.0% after elective subtotal colectomy compared with 5.3% in emergency subtotal colectomy, while in patients ≥60 years the corresponding risks were 3.3% and 18.4% . A recent report from Justiniano et al looked into the outcome of IBD‐related surgery in the state of New York 2000‐2013 . The 30‐day mortality was 0.4% in CD and 0.6% in UC in elective surgery and increased to 2.7% and 12.9%, respectively, in emergency surgery and increased with every 10‐year age increment of patients.…”

“…To conclude, there is a high risk of complications and mortality in IBD surgery among the elderly. Gastroenterologists and surgeons must work together to prevent unnecessarily high rates of emergency surgery, 43.9% in CD and 36.5% in UC . Although I may be biased by being a surgeon, I am far from convinced that this should be interpreted as a factor against surgery among elderly IBD patients when needed.…”

The Handling of the Rectal Stump Does Not Affect Severe Morbidity After Subtotal Colectomy For Ulcerative Colitis: A Retrospective Cohort Study

“…Subtotal colectomy with ileostomy and preservation of the rectal remnant is the preferred surgical treatment for patients with acute severe colitis refractory to medical treatment (1,2). In Sweden, the postoperative mortality rate after elective surgery is about 1%, but recent studies have shown mortality rates as high as 12.9% (3,4) after emergency colectomies. The morbidity after surgery is high, especially after emergency surgery, with figures about 30%-40% (2,(5)(6)(7)(8)(9).…”

Editor's choice

“…The 30‐day mortality was zero in this study but we need to watch out and work in close collaboration with our gastroenterologists. We do not want results like those in the recent publication on non‐elective surgery in IBD from the state of New York with a 30‐day mortality of 2.7% in Crohn's disease and 12.9% in ulcerative colitis .…”