The incidence of ulcerative colitis (UC) in the elderly population is increasing. The aim of this study was to assess the degree to which age and other factors increase the risk of developing major complications in patients undergoing elective surgery for UC.
Methods
Using the ACS-NSQIP database from 2016 to 2020, patients undergoing elective surgery for UC were divided into four categories: younger than 30, 30-49, 50-69, and 70 or older. A composite outcome was created including major complications and multivariable analysis was performed to identify factors associated with composite major complications.
Results
5946 patients diagnosed with ulcerative colitis who underwent elective surgery were included in the analysis. 14.1% of all patients developed a major complication. For patients with UC, factors associated with the development of a major complication were age 50-69 (OR 1.31, P = .034), male sex (OR 1.38, P < .001), Black race (OR 1.47, P = .049), dependent status (OR 2.06, P = .028), hypoalbuminemia (OR 1.92, P < .001), preoperative steroid treatment (OR 1.27, P = .038), preoperative transfusion (OR 1.91, P < .001), open surgical approach (OR 1.44, P = .002), and partial colectomy (OR 1.51, P = .007). Specifically in patients aged 70 or older, hypoalbuminemia (OR 3.20, P < .001) and preoperative transfusion (OR 2.78, P = .019) were associated with a major complication.
Conclusion
Age is a risk factor for the development of a major complication in UC patients undergoing elective surgery. However, it is not the only risk factor nor is it the one that increases the risk the most.
KeyashianKDehghanMSceatsLKinCLimketkaiBNParkKT. Comparative incidence of inflammatory bowel disease in different age groups in the United States. Inflamm Bowel Dis. 2019;25(12):1983-1989. doi:10.1093/ibd/izz092
2.
HruzPJuilleratPKullak-UblickG-ASchoepferAMMantzarisGJRoglerG. Management of the elderly inflammatory bowel disease patient. Digestion. 2020;101(Suppl. 1):105-119. doi:10.1159/000503099
3.
JeuringSFvan den HeuvelTRZeegersMP, et al.Epidemiology and long-term outcome of inflammatory bowel disease diagnosed at elderly age-an increasing distinct entity?Inflamm Bowel Dis. 2016;22(6):1425-1434. doi:10.1097/mib.0000000000000738
4.
BautistaMCOttersonMFZadvornovaY, et al.Surgical outcomes in the elderly with inflammatory bowel disease are similar to those in the younger population. Dig Dis Sci. 2013;58(10):2955-2962. doi:10.1007/s10620-013-2754-2
5.
SacleuxS-CSarterHFumeryM, et al.Post-operative complications in elderly onset inflammatory bowel disease: a population-based study. Aliment Pharmacol Ther. 2018;47(12):1652-1660. doi:10.1111/apt.14790
6.
NguyenGCTargownikLESinghH, et al.The impact of inflammatory bowel disease in Canada 2018: IBD in seniors. J Can Assoc Gastroenterol. 2018;2(Suppl. 1):S68-S72. doi:10.1093/jcag/gwy051
7.
LeBlancJFWisemanDLakatosPLBessissowT. Elderly patients with inflammatory bowel disease: updated review of the therapeutic landscape. World J Gastroenterol. 2019;25(30):4158-4171.
8.
BollegalaNJacksonTDNguyenGC. Increased postoperative mortality and complications among elderly patients with inflammatory bowel diseases: an analysis of the national surgical quality improvement program cohort. Clin Gastroenterol Hepatol. 2016;14:1274-1281.
9.
CohanJNBacchettiPVarmaMGFinlaysonE. Outcomes after ileoanal pouch surgery in frail and older adults. J Surg Res. 2015;198:327-333.
10.
PedersenKEJiaXHolubarSDSteeleSRLightnerAL. Ileal pouch-anal anastomosis in the elderly: a systematic review and meta‚Äêanalysis. Colorectal Dis. 2021;23(8):2062-2074. doi:10.1111/codi.15665
AlluriRKLelandHHeckmannN. Surgical research using national databases. Ann Transl Med. 2016;4(20):393. PMID: 27867945; PMC5107400. doi:10.21037/atm.2016.10.49
13.
ChangSShenBRemziF. When not to pouch: important considerations for patient selection for ileal pouch-anal anastomosis. Gastroenterol Hepatol (NY). 2017;13(8):466-475. PMID: 28867978; PMCID: PMC5572960.
14.
ColomboFSahamiSde Buck Van OverstraetenA, et al.Restorative proctocolectomy in elderly IBD patients: a multicentre comparative study on safety and efficacy. J Crohn's Colitis. 2016;11(6):671-679. doi:10.1093/ecco-jcc/jjw209
15.
LoBDStemMZhangGQ, et al.The reduced risk of septic shock/sepsis with laparoscopic surgery among ulcerative colitis patients with preoperative chronic steroid use. Surgery. 2021;170(4):1047-1053. doi:10.1016/j.surg.2021.03.058
16.
LiYWangSGaoSYangCYangWGuoS. Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy. Tech Coloproctol. 2016;20(3):153-162. Epub 2016 Jan 18. PMID: 26783029. doi:10.1007/s10151-015-1419-x
17.
HotaSParascandolaSAmdurRObiasV. Evaluation of minimally invasive surgical therapies for ulcerative colitis. Am Surg. 2020;86(7):782-786. Epub 2020 Jul 31. PMID: 32735453. doi:10.1177/0003134820934417
18.
HamelMBHendersonWGKhuriSFDaleyJ. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424-429. PMID: 15743284. doi:10.1111/j.1532-5415.2005.53159.x
McKennaNPGlasgowAECimaRRHabermannEB. Risk factors for organ space infection after ileal pouch anal anastomosis for chronic ulcerative colitis: an ACS NSQIP analysis. Am J Surg. 2018;216:900-905.
21.
Abd El AzizMACaliniGGrassFBehmKTD' AngeloA-LShawkiS, et al.Minimally invasive ileal pouch-anal anastomosis for patients with obesity: a propensity score-matched analysis. Langenbeck's Arch Surg. 2021;406:2419-2424.
22.
OreASVignaCFabrizioAMessarisE. Evaluation of racial/ethnic disparities in the surgical management of inflammatory bowel disease. J Gastrointest Surg. 2022;26(12):2559-2568. Epub 2022 Oct 17. PMID: 36253503. doi:10.1007/s11605-022-05483-x
23.
RaviPSoodASchmidMAbdollahFSammonJDSunM, et al.Racial/ethnic disparities in perioperative outcomes of major procedures: results from the national surgical quality improvement program. Ann Surg. 2015;262(6):955-964. PMID: 26501490. doi:10.1097/SLA.0000000000001078
24.
TaylorKKNeimanPUBonnerSRanganathanKTipirneniRScottJW. Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the national health interview survey. Ann Surg. 2023;278(2):193-200. Epub 2022 Aug 26. PMID: 36017938; PMCID: PMC10122453. doi. 10.1097/SLA.0000000000005689
25.
Abd El AzizMAPerryWRGGrassFMercheaARaffalsLEMathisKLBehmKT. The extent of colorectal resection and short-term outcomes in patients with ulcerative colitis. Updates Surg. 2021;73(4):1429-1434. Epub 2021 Mar 30. PMID: 33783765. doi:10.1007/s13304-021-01040-4
26.
GibbsJCullWHendersonWDaleyJHurKKhuriSF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36-42. PMID: 9927128. doi:10.1001/archsurg.134.1.36
27.
ChristinaNMTjahyantoTLieJGSantosoTAAlbertusHOctavianusD, et al.Hypoalbuminemia and colorectal cancer patients: any correlation? A systematic review and meta-analysis. Medicine. 2023;102:e32938.
28.
HardtJPilzLMagdeburgJKienlePPostSMagdeburgR. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis. 2017;32(10):1439-1446. Epub 2017 Aug 19. PMID: 28823064. doi:10.1007/s00384-017-2884-7
29.
ToritaniKKimuraHFukuokaHWatanabeJIshibeAKunisakiR, et al.Preoperative risk factors of incisional surgical site infection in severe or intractable ulcerative colitis. Surg Today. 2022;52(3):475-484. Epub 2021 Aug 13. PMID: 34387734. doi:10.1007/s00595-021-02354-x
30.
IraniJLHedrickTLMillerTELeeLSteinhagenEShoganBD, et al.Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the american society of colon and rectal surgeons and the society of american gastrointestinal and endoscopic surgeons. Dis Colon Rectum. 2023;66(1):15-40. Epub 2022 Dec 7. PMID: 36515513; PMCID: PMC9746347. doi. 10.1097/DCR.0000000000002650
