Farrukh Affifa, Mayberry John Francis
Nuffield Hospital, Leicester LE5 1HY, UK.
J Clin Med. 2022 Aug 24;11(17):4967. doi: 10.3390/jcm11174967.
Over the last decade, there has been extensive evidence that patients with inflammatory bowel disease from minority communities in the UK receive less than optimal care. In none of the studies has the role of surgery in the management of acute and severe ulcerative colitis been considered in any detail. A freedom of information (FOI) request was sent to 14 NHS Trusts in England, which serve significant South Asian populations. Details of the type of surgery patients from the South Asian and White British communities received between 2021 and 2020 were requested. Detailed responses were obtained from eight Trusts. Four hundred and ten White British patients underwent surgery for ulcerative colitis over this period at these eight Trusts, together with 67 South Asian patients. There was no statistically significant difference in the distribution across the types of surgery undergone by the two communities overall (χ = 1.3, ns) and the proportions who underwent an ileo-anal anastomosis with pouch (z = -1.2, ns). However, within individual trusts, at the University Hospital Southampton NHS Foundation Trust, a significantly greater proportion of South Asian patients had an ileo-anal anastomosis with pouch compared to White British patients. At Cambridge University Hospitals NHS Foundation Trust, all 72 patients who underwent surgery for ulcerative colitis were White British. This study has shown that, in general, for patients with a severe flare of ulcerative colitis where medical treatment has failed and surgery is warranted, the nature of the procedures offered is the same in the White British and South Asian communities. However, of concern is the number of units with low volume procedures. For most Trusts reported in this study, the overall number of Ileo-anal pouch anastomosis or anastomosis of ileum to anus procedures performed over a number of years was substantially below that required for a single surgeon to achieve competence. These findings reinforce the argument that inflammatory bowel disease surgery should be performed in a limited number of high-volume centres rather than across a wide range of hospitals so as to ensure procedures are carried out by surgeons with sufficient and on-going experience.
在过去十年中，有大量证据表明，英国少数族裔社区的炎症性肠病患者接受的治疗未达最佳水平。在任何一项研究中，均未详细考虑手术在急性和重度溃疡性结肠炎管理中的作用。向英格兰的14家国民保健服务信托基金发送了信息自由（FOI）请求，这些信托基金服务于大量南亚人群。请求提供2021年至2020年间南亚和英国白人社区患者接受的手术类型细节。从8家信托基金获得了详细回复。在此期间，这8家信托基金有410名英国白人患者接受了溃疡性结肠炎手术，还有67名南亚患者。总体而言，两个社区接受的手术类型分布没有统计学上的显著差异（χ = 1.3，无显著性差异），以及接受回肠肛管吻合术加储袋的比例也没有差异（z = -1.2，无显著性差异）。然而，在个别信托基金中，在南安普敦大学医院国民保健服务基金会信托基金，与英国白人患者相比，接受回肠肛管吻合术加储袋的南亚患者比例显著更高。在剑桥大学医院国民保健服务基金会信托基金，所有72名接受溃疡性结肠炎手术的患者都是英国白人。这项研究表明，一般来说，对于溃疡性结肠炎严重发作且药物治疗失败需要手术的患者，英国白人和南亚社区提供的手术程序性质相同。然而，令人担忧的是低手术量单位的数量。对于本研究中报告的大多数信托基金来说，多年来进行的回肠肛管储袋吻合术或回肠与肛门吻合术的总数大大低于单个外科医生达到胜任水平所需的数量。这些发现强化了这样一种观点，即炎症性肠病手术应在少数高手术量中心进行，而不是在广泛的医院进行，以确保手术由有足够且持续经验的外科医生进行。
