Risk factors for postoperative infection after gastrointestinal surgery among adult patients with inflammatory bowel disease: Findings from a large observational US cohort study

Abstract

Background and AimPostoperative infection (POI) is a major source of morbidity and prolongation of hospitalization in inflammatory bowel disease (IBD) patients. This large observational study was conducted to further describe risk factors and to quantify the proportion of POIs that are preventable.MethodsWe conducted a retrospective cohort analysis of the Optum US health insurance claims database. The study population included adults with ulcerative colitis (UC) or Crohn's disease (CD) who underwent lower gastrointestinal (GI) surgery of small intestine, colon, rectum, or anus during September 2014 to September 2016. Multiple logistic regression was used to identify and quantify risk factors and determine the proportion of infections that are preventable.ResultsA total of 3360 adult IBD patients with lower GI surgery were included in the study. Their mean age was 51 years, 52.5% were women, and 59.5% had CD. The 30‐day POI incidence was 15.1% (95% confidence interval: 14.0–16.4%). We identified the following nonmodifiable or procedural risk factors: history of POI, open procedure, red blood cell transfusion within 6 months, preoperative hospital stay of at least 4 days, lower GI ostomy surgery, lower GI resection surgery, and a history of chronic obstructive pulmonary disease. Modifiable risk factors included corticosteroid use and anemia prior to surgery, but few infections were attributable to these modifiable factors.ConclusionsThis large, observational, real‐world evidence study from the US found that the majority of the observed risk factors were nonmodifiable or procedure‐related. Corticosteroid use and anemia before surgery were identified as modifiable risk factors.

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

“…Albumin and nutritional status are also essential factors to evaluate during preoperatory management, despite the fact that a higher risk of complications has been observed in those patients with mixed or exclusive parenteral nutrition [ 47 ]. Of note, corticosteroids and hypoalbuminaemia are intimately associated with other factors involved in postoperative complications such as anaemia, the temporality of surgery or the surgical approach [ 48 , 49 , 50 ]. Regarding anaemia, only one study analysed the association between its severity and the risk of complications in IBD [ 51 ].…”

Roles of Macrophages in the Development and Treatment of Gut Inflammation

“…Moreover, IBD is incurable and increases the risk of lymphoma, cholangiocarcinoma, and colorectal cancer ( Samadder et al, 2019 ; Scharl et al, 2019 ). Many patients with IBD have to undergo surgery multiple times to relieve symptoms, which may lead to postoperative complications and infections, adversely affecting their quality of life ( Torres et al, 2017 ; Ungaro et al, 2017 ; Liang et al, 2018 ). There have been some—although relative few—experiments using immunomodulators for IBD treatment, but the effect of the treatment declines with time ( Torres et al, 2017 ; Ungaro et al, 2017 ; Friedrich et al, 2019 ).…”

Epidemiological characteristics of postoperative sepsis

“…After radical gastrectomy for gastric cancer, post-operative infection is the most common complication via leukocyte depletion in transfusion patient [20]. Postoperative infection is the lethal and hospitalized factor in patients who underwent lower gastrointestinal surgery of the small intestine, colon, rectum, or anus in Unit State [21]. Studies had shown that patients who underwent surgical esophagectomy had a high risk of postoperative complications such as sepsis and high mortality [22].…”