Some 3.6% of patients with Crohn disease (CD) and 5.3% of patients with ulcerative colitis (UC) died after emergent intestinal resection, but for patients with either disease, postoperative mortality risk decreased significantly with elective surgery, according to a meta-analysis published in the October issue of Gastroenterology.
“The setting in which the surgery was performed had the greatest impact on the risk of postoperative mortality. Emergent surgery for [inflammatory bowel disease (IBD)] was associated with the highest mortality,” write Sunny Singh, MD, from the Division of Gastroenterology, University of Calgary, Alberta, Canada, and coauthors.
CD and UC affect approximately 0.5% of people living in developed nations, according to the authors. And 10 years after diagnosis, their risks for intestinal surgery range from 47% to 16%, respectively.
Searching the literature, the researchers found 18 articles and three abstracts of population-based studies that reported postoperative mortality among 67,057 patients with UC and 75,971 patients with CD who underwent surgery after 1990.
Patients with IBD who underwent emergency surgeries had more severe disease activity and were more likely to require surgery for complications, including obstruction; such unplanned surgeries were more likely to be performed by general surgeons. Postoperative mortality was much lower with elective surgery (0.6% for CD and 0.7% for UC), in which there is greater use of laparoscopic surgeries.
“Although a mortality risk of 0.6%–0.7% is low, appropriate patient selection may allow for a further reduction in postoperative mortality,” Dr Singh and colleagues write. Although the researchers lacked sufficient data to assess the effect of age on mortality, a prior study indicated that the risk of dying after elective surgery was as low as 0.1% for patients aged 18 to 34 years with IBD and one or fewer comorbidities.
When the authors stratified the data in terms of when the surgery was performed, they found that postoperative mortality rates decreased over time among patients with CD (P < .05), but there was no change among those with UC (P = .21).
“This systematic review and meta-analysis has documented the pooled postoperative mortality for UC and CD after an intestinal resection stratified by time, geography, and elective vs emergent surgical cases,” Dr Singh and coauthors conclude. “The findings suggest that clinicians should optimize medical management to avoid emergent surgeries and prioritize research toward reducing mortality associated with emergent surgeries.”