Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
Center for Inflammatory Bowel Diseases, Vatche & Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, USA.
J Gastrointest Surg. 2021 Jan;25(1):211-219. doi: 10.1007/s11605-020-04832-y. Epub 2020 Nov 2.
Medical therapy for inflammatory bowel disease (IBD) has markedly advanced since the introduction of biologic therapeutics, although surgery remains an important therapeutic strategy for both Crohn's disease (CD) and ulcerative colitis (UC). This study evaluated how rates of bowel resection surgery and post-operative mortality for IBD have changed over the last decade in the era of biologic therapies.
The Nationwide Readmission Database (NRD) was queried for patients with IBD (based on ICD-9 and -10 diagnosis and procedure codes) who were hospitalized between 2010 and 2017. Longitudinal trends in bowel resection surgery, urgent surgery, and post-operative mortality were analyzed.
During the 8-year period, a total of 1795,266 IBD-related hospitalizations (1,072,110 with CD and 723,156 with UC) were evaluated. There was an increase in the annual number of IBD patients hospitalized, but a statistically significant decrease in the proportion of IBD patients undergoing surgery, from 10 to 8.8% (p < 0.001) for CD and 7.7 to 7.5% (p < 0.001) for UC. From 2014 through 2017, the proportion of urgent surgeries remained stable around 25% (p = 0.16) for CD and decreased from 21 to 14% (p < 0.001) for UC. For CD, the rate of post-operative 30-day mortality varied between 1.2 and 1.6% and for UC decreased from 5.8 to 2.3% (p < 0.001).
Analysis of a nationwide dataset from 2010 to 2017 determined that despite an increase in total admissions for IBD, a smaller proportion of hospitalized patients underwent surgery. A greater proportion of surgeries for UC were performed on an elective basis, and overall the rates of post-operative mortality for CD and UC decreased. The growth of biologic medical therapy during the study period highlights a probable contributing factor for the observed changes.
自生物治疗药物问世以来，炎症性肠病（IBD）的医学治疗已取得显著进展，尽管手术仍然是克罗恩病（CD）和溃疡性结肠炎（UC）的重要治疗策略。本研究评估了在生物治疗时代，过去十年中 IBD 患者的肠切除术和术后死亡率的变化情况。
通过国家再入院数据库（NRD）查询了 2010 年至 2017 年间住院的 IBD 患者（基于 ICD-9 和 ICD-10 诊断和手术代码）。分析了肠切除术、急诊手术和术后死亡率的纵向趋势。
在 8 年期间，共评估了 1795266 例 IBD 相关住院治疗（1072110 例 CD 和 723156 例 UC）。住院的 IBD 患者数量逐年增加，但接受手术的 IBD 患者比例从 10%下降到 8.8%（p<0.001），CD 从 7.7%下降到 7.5%（p<0.001），UC 则保持稳定。从 2014 年到 2017 年，CD 的急诊手术比例保持在 25%左右（p=0.16），UC 则从 21%下降到 14%（p<0.001）。CD 的术后 30 天死亡率在 1.2%至 1.6%之间波动，UC 则从 5.8%下降到 2.3%（p<0.001）。
对 2010 年至 2017 年全国范围内数据集的分析表明，尽管 IBD 总住院人数增加，但接受手术的住院患者比例较小。UC 的手术更多地采用择期手术，CD 和 UC 的术后死亡率总体下降。研究期间生物医学治疗的发展突显了观察到的变化的一个可能的促成因素。
