Sex-Based Differences in Inflammatory Bowel Disease Surgical Outcomes

Sundel, Margaret H.; Newland, John J.; Blackburn, Kyle W.; Vesselinov, Roumen M.; Eisenstein, Samuel; Bafford, Andrea C.; ,

doi:10.1097/dcr.0000000000002984

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…A total of 13 studies (19.4%) examined corticosteroid use [ 36 , 42 , 45 , 59 , 64 , 70 , 72 , 75 , 85 – 89 ] (Table 3 ), of which only 2 studies (15.4%) reported a statistically significant sex-based difference in the use of corticosteroids, with fewer male patients using a corticosteroid (budesonide) than female patients for both CD and UC in one study [ 64 ] and fewer female patients using steroids for total IBD patients in the other study [ 89 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Rasmussen,

Moos,

Gregersen

et al. 2024

Syst Rev

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Background Inflammatory bowel diseases (IBDs) are associated with high healthcare utilization. This systematic review aimed to summarize what is known about the impact of sex, income, and education on the likelihood of bowel surgery, hospitalization, and use of corticosteroids and biologics among patients with IBD. Methods We used EMBASE, MEDLINE, CINAHL, and Web of Science to perform a systematic literature search. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis for the impact of sex on the likelihood of surgery and hospitalization. In addition, we performed subgroup analyses of the effect of IBD type (Crohn’s disease or ulcerative colitis) and age. Finally, meta-regression was undertaken for the year of publication. Results In total, 67 studies were included, of which 23 studies were eligible for meta-analysis. In the main meta-analysis, male sex was associated with an increased likelihood of bowel surgery (HR 1.42 (95% CI 1.13;1.78), which was consistent with the subgroup analysis for UC only (HR 1.78, 95% CI 1.16; 2.72). Sex did not impact the likelihood of hospitalization (OR 1.05 (95% CI 0.86;1.30), although the subgroup analysis revealed an increased likelihood of hospitalization in CD patients (OR 1.42, 95% CI 1.28;1.58). In 9 of 10 studies, no significant sex-based differences in the use of biologics were reported, although in 6 of 6 studies, female patients had lower adherence to biologics. In 11 of 13 studies, no significant sex-based difference in the use of corticosteroids was reported. The evidence of the impact of income and education on healthcare utilization was sparse and pointed in different directions. The substantial heterogeneity between studies was explained, in part, by differences in IBD type and age. Conclusions The results of this systematic review indicate that male patients with IBD are significantly more likely to have surgery than female patients with IBD but are not, overall, more likely to be hospitalized, whereas female patients appear to have statistically significantly lower adherence to biologics compared to male patients. Thus, clinicians should not underestimate the impact of sex on healthcare utilization. Evidence for income- and education-based differences remains sparse. Systematic review registration PROSPERO CRD42022315788.

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Section: Resultsmentioning

confidence: 99%

“…In this review, only 2 of the 13 studies found statistically significant sex-based differences in corticosteroids, and with contradictive results [ 64 , 89 ]. No studies examining sex and adherence to corticosteroids were identified.…”

Section: Discussionmentioning

confidence: 99%

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Rasmussen,

Moos,

Gregersen

et al. 2024

Syst Rev

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Association of Race and Postoperative Outcomes in Patients with Inflammatory Bowel Disease

Newland,

Sundel,

Blackburn

et al. 2024

Dig Dis Sci

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Factors Affecting Surgical Outcomes in IBD Patients

Buldukoglu

2024

Diseases of the Colon &Amp; Rectum

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To the Editor-I congratulate Sundel et al on their study 1 entitled "Sex-Based Differences in IBD Surgical Outcomes, " which I read with great interest. The study revealed that postoperative serious adverse events were 27% less common in women compared to men with IBD, with no difference between 2 groups for anastomotic leaks or wound complications. This association was statistically significant for the ulcerative colitis group only (OR: 0.46, 95% CI: 0.28-0.74, p = 0.001) in subgroup analysis.IBDs affect approximately 1% of the population, and although treatment options are increasing in number lately with biologic and small-molecule therapies, a significant portion of patients still require surgical interventions during the disease course. 2,3 Apart from the wide array of covariates included in study data by Sundel et al, 1 there are additional factors that can affect disease course and development of postsurgical complications and thus alter the results of the study. Medications used for disorders accompanying IBD (eg, nonsteroidal anti-inflammatory drugs, preoperative hypoalbuminemia, and/or hypoproteinemia), preoperative hospitalization requirement, and comorbidities accompanying IBD (eg, bleeding disorders) are known determinants to alter operative and postoperative serious adverse event risks. [4][5][6] In addition, early onset IBD predicts a worse disease course, making it essential to include disease onset and duration in the analysis. 7 In conclusion, the article by Sundel et al contributes greatly and is a pioneer study in evaluating the sex-based differences in surgical outcomes of patients with IBD. Future studies taking into account an extended list of variables would shed more light on this intriguing topic.

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Sex-Based Differences in Inflammatory Bowel Disease Surgical Outcomes

Cited by 3 publications

References 30 publications

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Association of Race and Postoperative Outcomes in Patients with Inflammatory Bowel Disease

Factors Affecting Surgical Outcomes in IBD Patients

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