Bazerbachi Fateh, Sawas Tarek, Vargas Eric J, Haffar Samir, Deepak Parakkal, Kisiel John B, Loftus Edward V, Abu Dayyeh Barham K
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Digestive Center for Diagnosis & Treatment, 29 Ayar Street, Damascus, Syrian Arab Republic.
Obes Surg. 2018 Apr;28(4):1007-1014. doi: 10.1007/s11695-017-2955-4.
The prevalence of obesity in patients with inflammatory bowel disease (IBD) has increased over the past decades. Data to support the safety of bariatric surgery (BAR) in IBD remain scarce. Our aim was to evaluate the safety and early postoperative complications of BAR in IBD patients.
We used the Nationwide Inpatient Sample (NIS) 2011, 2012, and 2013 to perform a cohort study. The study group was all hospitalized patients between ages 18-90 years who underwent BAR with a discharge diagnosis of IBD as per the Ninth International Classification of Diseases codes (ICD-9). Adults who underwent BAR without ICD-9 codes of IBD were identified as the comparison group. Complications were compared using multivariate logistic regression analysis.
We identified 314,864 adult patients who underwent BAR between 2011 and 2013. Mean age was 45.5 ± 0.11 years, and 79% were females. Seven hundred and ninety patients had underlying IBD; 459 had Crohn's disease and 331 had ulcerative colitis. The remaining patients formed the comparison group. Mean length of hospital stay (LOS) was longer in the IBD group by 1 day (p = 0.01). The IBD group had a significantly higher risk of perioperative small bowel obstruction (SBO) (adjusted odds ratio, 4.0; 95%, CI; 2.2-7.4). Other technical and systemic complications were similar between the two groups, with no mortality reported in the IBD group.
BAR in IBD patients has an acceptable safety profile, with immeditae risk limited to perioperative SBO and an apparently low risk of mortality or other major immediate postoperative complications.
在过去几十年中，炎症性肠病（IBD）患者的肥胖患病率有所上升。支持肥胖症手术（BAR）在IBD患者中安全性的数据仍然很少。我们的目的是评估BAR在IBD患者中的安全性和术后早期并发症。
我们使用2011年、2012年和2013年的全国住院患者样本（NIS）进行队列研究。研究组为所有年龄在18 - 90岁之间、根据第九版国际疾病分类代码（ICD - 9）出院诊断为IBD且接受BAR的住院患者。接受BAR但无IBD的ICD - 9代码的成年人被确定为对照组。使用多因素逻辑回归分析比较并发症。
我们确定了2011年至2013年间接受BAR的314,864名成年患者。平均年龄为45.5±0.11岁，79%为女性。790名患者患有潜在的IBD；459名患有克罗恩病，331名患有溃疡性结肠炎。其余患者组成对照组。IBD组的平均住院时间（LOS）长1天（p = 0.01）。IBD组围手术期小肠梗阻（SBO）的风险显著更高（调整后的优势比，4.0；95%，CI；2.2 - 7.4）。两组之间的其他技术和全身并发症相似，IBD组未报告死亡病例。
IBD患者的BAR具有可接受的安全性，即刻风险仅限于围手术期SBO，且死亡或其他主要术后即刻并发症的风险明显较低。
