老年发病炎症性肠病的术后并发症：一项基于人群的研究。

Post-operative complications in elderly onset inflammatory bowel disease: a population-based study.

机构信息

Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France.

Public Health, Epidemiology and Economic Health, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.

出版信息

Aliment Pharmacol Ther. 2018 Jun;47(12):1652-1660. doi: 10.1111/apt.14790. Epub 2018 May 8.

DOI:10.1111/apt.14790

PMID:29737553

Abstract

BACKGROUND

IBD diagnosed after the age of 60 is increasing. Data on post-operative complications in elderly onset IBD are scarce.

AIM

To describe the incidence of and factors associated with post-operative complications in elderly onset IBD, diagnosed after the age of 60.

METHODS

Using EPIMAD Cohort (1988-2006), among 841 incident IBD patients, 139 (17%) underwent intestinal surgery, including 100 Crohn's disease (CD) and 39 ulcerative colitis (UC).

RESULTS

After a median post-operative follow-up of 6 years (2-10), 50 (36%) patients experienced at least 1 complication with a total of 69. During the first 30 post-operative days, the mortality rate was 4%. Thirty-two early complications (<30 days) were observed in 23 patients (17%), with 15 infectious, without significant difference between CD and UC. More than half early post-operative complications (n = 19, 59%) were severe (>grade 2) without significant difference between CD and UC (P = 0.28). Thirty-seven long-term adverse effects of surgical therapy (≥30 days) were observed in 33 patients (24%). Multivariate analysis found (1) acute severe colitis (OR = 7.84 [2.15-28.52]) and emergency surgery (OR = 4.46 [1.75-11.36]) were associated with early post-operative complications, and (2) Female gender (HR = 2.10 [1.01-4.37]) and delay before surgery >3 months (HR = 2.09 [1.01-4.31]) with long-term adverse effects of surgical therapy.

CONCLUSIONS

One-third of elderly IBD patients experienced at least 1 post-operative complication. Half of the early complications were severe, and infectious. Emergency surgery was the key driver for post-operative complication.

摘要

背景

60 岁后诊断出的 IBD 正在增加。关于老年发病 IBD 的术后并发症的数据很少。

目的

描述 60 岁后诊断出的老年发病 IBD 患者术后并发症的发生率和相关因素。

方法

使用 EPIMAD 队列（1988-2006 年），在 841 例 IBD 患者中，有 139 例（17%）接受了肠道手术，其中包括 100 例克罗恩病（CD）和 39 例溃疡性结肠炎（UC）。

结果

在中位术后随访 6 年（2-10 年）后，有 50 名（36%）患者至少经历了一次并发症，共发生 69 次。在术后的头 30 天内，死亡率为 4%。在 23 名患者（17%）中观察到 32 例早期并发症（<30 天），其中 15 例为感染性并发症，CD 和 UC 之间无显著差异。超过一半的早期术后并发症（n=19，59%）较为严重（>2 级），CD 和 UC 之间无显著差异（P=0.28）。在 33 名患者（24%）中观察到 37 例手术治疗的长期不良影响（≥30 天）。多变量分析发现，（1）急性重度结肠炎（OR=7.84 [2.15-28.52]）和紧急手术（OR=4.46 [1.75-11.36]）与早期术后并发症相关，以及（2）女性（HR=2.10 [1.01-4.37]）和手术前延迟时间>3 个月（HR=2.09 [1.01-4.31]）与手术治疗的长期不良影响相关。