Outcomes after a Colectomy Among Elderly with Inflammatory Bowel Disease
Resident PGY 4
Henry Ford Hospital
Purpose/Background: The average age of surgical patients with inflammatory bowel disease (IBD) is rising, and understanding morbidity and mortality unique to these patients is important. Optimizing perioperative risk is significant to quality of care and outcomes. We sought to utilize a national database to evaluate surgical outcomes after colectomy in elderly patients with IBD.
Methods: We queried the 2016 NSQIP Targeted Colectomy Database to identify colectomies with an associated diagnosis of either Crohn’s Disease (CD) or Ulcerative Colitis (UC). Patients were categorized by age (<65 years vs. 65). Multivariate analysis was performed to derive independent predictors of 30-day morbidity and mortality.Results: There were 9,996 patients included in the study: 7,297 (73.0%) with CD and 2,699 (27.0%) with UC. Of these patients, 8,769 (87.7%) were less than 65 years and 1,227 (12.3%) were 65 years or older. On univariate analysis, elderly patients were associated with UC, diabetes, dyspnea, functional dependence, COPD, renal failure, bleeding disorders, and pre-operative sepsis. These cases were also more likely to be emergent, ASA Class 3 or higher, and have an increased length of stay. Multivariate analysis showed that elderly patients have a significantly increased risk of both morbidity (OR 1.36, 95% CI: 1.14-1.64, p<0.001) and mortality (OR 3.41, 95% CI: 1.99-5.85, p<0.001). Other predictors of morbidity and mortality are listed in Figures 1 and 2.
Conclusion: Elderly patients with IBD that undergo a colectomy are at increased risk for both morbidity and mortality. Further prospective research may help formulate optimization strategies to help reduce this risk.
Kandagatla, Pridvi; Tang, Amy; Reickert, Craig; and Stefanou, Amalia, "Outcomes after a Colectomy Among Elderly with Inflammatory Bowel Disease" (2019). Clinical Research. 40.