Authors: Singh S et al., Gastroenterology 2015 Jun 5;
Postoperative mortality is higher for emergent versus elective surgery in both ulcerative colitis and Crohn disease.
In the current meta-analysis, researchers evaluated postoperative mortality following intestinal resection in patients with inflammatory bowel disease (IBD). Twenty-one studies (18 articles and 3 abstracts) met the search criteria and involved 67,057 patients with ulcerative colitis and 75,971 patients with Crohn disease from 15 countries. All surgeries were performed after 1990.
In patients with ulcerative colitis, postoperative mortality was 0.7% with elective surgery and 5.3% with emergent surgery. In patients with Crohn disease, the respective rates were 0.6% and 3.6%. Postoperative mortality rates did not vary between ulcerative colitis and Crohn disease for either elective or emergent surgery. During the 25 years of observation, postoperative mortality decreased in Crohn disease but not ulcerative colitis.
The authors suggest that clinicians should optimize medical therapy and try to avoid emergent surgery because of its high mortality in patients with IBD. Of course, in many instances, if medical therapy were working in emergent situations, there would be no need for emergent surgery.