Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY.
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY.
Ann Surg. 2018 Aug;268(2):311-317. doi: 10.1097/SLA.0000000000002275.
To investigate differences in surgical approach and postoperative outcomes for patients with ulcerative colitis (UC) before and after the introduction of biologic therapy.
Biologic use has dramatically increased since Food and Drug Administration approval of infliximab. Studies conflict as to the effect of these agents on surgical outcomes with some demonstrating worse surgical outcomes whereas others have found no difference.
We used an administrative, all-payer, all-age group database located in New York State. Patients were included if they had a diagnosis of UC and underwent surgery for their disease from 1995 to 2013. Outcomes were compared for the index admission, at 90-day, and 1-year follow up.
A total of 7070 patients were included for analysis; 54% patients underwent surgery between 1995 and 2005 and the remaining 46% patients underwent surgery between 2005 and 2013. There was a significant increase in the proportion of patients who underwent at least 3 procedures after 2005(14% vs 9%, P < 0.01). On adjusted analysis, patients undergoing surgery after 2005 had higher likelihood of major events (odd s ratio, OR = 1.42; 95% confidence interval, CI = 1.13-1.78), procedural complications (OR = 1.42; 95% CI = 1.20-1.68), and nonroutine discharge (OR = 3.17; 95% CI = 2.79-3.60) during the index admission. Similar trends for worse adjusted outcomes in patients initially undergoing surgery after 2005 were seen at 90-day and 1-year follow up.
Since the introduction of biologic agents in 2005, surgery for patients with UC is more likely to require multiple procedures. Despite robust adjustments, patients having surgery recently have worse postoperative morbidity during the index hospitalization, at 90-day and 1-year follow up. More work is necessary to improve outcomes in these higher risk patients that undergo surgery.
研究在引入生物制剂前后溃疡性结肠炎（UC）患者手术方式和术后结果的差异。
自美国食品和药物管理局批准英夫利昔单抗以来，生物制剂的使用显著增加。一些研究表明这些药物会对手术结果产生不利影响，而另一些研究则没有发现差异，因此关于这些药物对手术结果的影响存在争议。
我们使用了位于纽约州的一个行政性、全民付费、全年龄段的数据库。纳入的患者有溃疡性结肠炎的诊断，并在 1995 年至 2013 年期间因该病接受手术。比较了索引入院、90 天和 1 年随访时的结果。
共纳入 7070 例患者进行分析；54%的患者在 1995 年至 2005 年期间接受手术，其余 46%的患者在 2005 年至 2013 年期间接受手术。2005 年后接受至少 3 种手术的患者比例显著增加（14%比 9%，P<0.01）。调整分析显示，2005 年后接受手术的患者主要不良事件（优势比，OR=1.42；95%置信区间，CI=1.13-1.78）、手术并发症（OR=1.42；95%CI=1.20-1.68）和非常规出院（OR=3.17；95%CI=2.79-3.60）的可能性更高在索引入院期间。在 90 天和 1 年随访时，最初在 2005 年后接受手术的患者也有类似的调整后结果较差的趋势。
自 2005 年生物制剂问世以来，UC 患者的手术更有可能需要多次手术。尽管进行了强有力的调整，但最近接受手术的患者在索引住院期间、90 天和 1 年随访时的术后发病率更高。需要进一步努力改善这些高风险患者的手术结果。
