Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada.
University Health Network, Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Clin Gastroenterol Hepatol. 2016 Sep;14(9):1274-81. doi: 10.1016/j.cgh.2015.11.012. Epub 2015 Dec 2.
BACKGROUND & AIMS: Elderly patients may be at increased risk for poor outcomes after surgery for inflammatory bowel disease (IBD). We investigated postoperative mortality and the incidence of complications in elderly patients with IBD.
We identified patients who underwent major IBD-related abdominal surgery using the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files, from 2005 through 2012. We compared mortality and postoperative complications between elderly patients (≥65 years old) and nonelderly patients (<65 years old).
We identified 15,495 IBD patients who underwent surgery; of these, 1707 (11%) were elderly. Postoperative 30-day mortality was higher among elderly patients with Crohn's disease (CD) (4.2% vs 0.3% in nonelderly patients; P < .001) or ulcerative colitis (UC) (6.1% vs 0.7%; P < .001). After accounting for potential confounders, the adjusted odds ratio (aOR) of postoperative mortality in patients with CD was 11.67 (95% confidence interval [CI], 5.99-22.74), and in patients with UC was 4.39 (95% CI, 2.49-7.72). Postoperative complications were more common among elderly patients with CD (28.0% vs 19.4% in nonelderly patients; P < .001) or UC (39.3% vs 23.6% in elderly patients; P < .001). The aOR for any postoperative complication (excluding death) was 1.40 (95% CI, 1.16-1.69) in patients with CD and 1.74 for patients with UC (95% CI, 1.49-2.05). Elderly patients with UC were at increased risk for infectious complications, compared with nonelderly patients (aOR, 1.52; 95% CI, 1.27-1.82). The risk of postoperative venous thromboembolism was higher in elderly patients with CD (aOR, 1.68; 95% CI, 1.04-2.73). A higher proportion of elderly patients was still in the hospital more than 30 days after surgery (5.0% vs 1.8% for nonelderly patients; P < .001).
Elderly patients with IBD have substantially higher postoperative mortality and more complications than nonelderly patients with IBD. These increased risks should be considered when comparing risks of surgical vs medical therapy in this population.
老年患者在接受炎症性肠病（IBD）手术后可能面临更高的不良结局风险。我们调查了老年 IBD 患者的术后死亡率和并发症发生率。
我们使用美国外科医师学院国家外科质量改进计划参与者使用文件，从 2005 年至 2012 年确定了接受主要 IBD 相关腹部手术的患者。我们比较了老年患者（≥65 岁）和非老年患者（<65 岁）之间的死亡率和术后并发症。
我们确定了 15495 例 IBD 患者接受了手术；其中 1707 例（11%）为老年患者。患有克罗恩病（CD）的老年患者术后 30 天死亡率更高（4.2% vs 非老年患者的 0.3%；P<.001）或溃疡性结肠炎（UC）（6.1% vs 非老年患者的 0.7%；P<.001）。在考虑潜在混杂因素后，CD 患者术后死亡的调整优势比（aOR）为 11.67（95%置信区间[CI]，5.99-22.74），UC 患者为 4.39（95%CI，2.49-7.72）。患有 CD 的老年患者术后并发症更为常见（28.0% vs 非老年患者的 19.4%；P<.001）或 UC（39.3% vs 非老年患者的 23.6%；P<.001）。患有 CD 的任何术后并发症（不包括死亡）的 aOR 为 1.40（95%CI，1.16-1.69），UC 患者为 1.74（95%CI，1.49-2.05）。与非老年患者相比，患有 UC 的老年患者感染性并发症的风险增加（aOR，1.52；95%CI，1.27-1.82）。患有 CD 的老年患者术后静脉血栓栓塞的风险更高（aOR，1.68；95%CI，1.04-2.73）。手术后仍有更多老年患者住院超过 30 天（5.0% vs 非老年患者的 1.8%；P<.001）。
与非老年 IBD 患者相比，老年 IBD 患者术后死亡率和并发症发生率明显更高。在比较该人群的手术治疗与药物治疗的风险时，应考虑这些增加的风险。
