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23-08-2011 | Surgery | Article

Comorbid disease increases in-hospital death risk following surgery in IBD


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MedWire News: Comorbidities are common in individuals undergoing surgery for inflammatory bowel disease (IBD) and significantly increase the risk for adverse postoperative clinical outcomes, research shows.

Mortality following surgery for IBD ranged from 0.4% in patients without additional disease to as high as 7.9% in those with three or more comorbidities, report investigators.

In addition, the presence of comorbidities in surgical IBD patients increased healthcare use, write Gilaad Kaplan (University of Calgary, Alberta, Canada) and colleagues in the journal Archives of Surgery.

For IBD patients who do not respond to medical treatment, surgery is usually recommended.

Although candidates for surgery are typically younger, and often have less comorbid disease, the risk for postoperative mortality remains high.

Factors known to influence the risk for postoperative outcomes include age, health insurance status, emergency operations, surgical experience, and comorbidities.

In the present study, Kaplan and colleagues analyzed a nationwide inpatient database that included 35,588 patients with IBD who underwent an IBD-related operation between 1995 and 2005.

The IBD patients were 42 years of age, on average, and approximately 25% had been admitted to the emergency room at some point before their operation.

Overall, the in-hospital mortality following surgery was 1.9%. The median length of stay was 8 days, and total hospital costs were US$ 29,150.

The presence of congestive heart failure was associated with a more than three-fold increased risk for in-hospital death following IBD surgery (odds ratio [OR]=3.50).

Similarly, the risk for in-hospital death increased more than two-fold in patients with cardiac arrhythmias (OR=2.29). Peripheral vascular disease in patients also increased the risk for in-hospital mortality (OR=2.33).

In addition, liver disease and renal failure significantly increased the risk for in-hospital mortality compared with patients without the conditions. Coagulopathy and fluid and electrolyte disorders were also prevalent and increased the risk for in-hospital death.

Overall, the presence of one additional disease/condition was associated with a postoperative mortality rate of 1.5%, while having two comorbidities was associated with an in-hospital mortality rate of 3.3%.

The 10% of patients with three or more comorbidities had an in-hospital death rate of 7.9%.

There was also a significant increase in hospital length of stay and hospital charges with the presence of comorbidities.

Based on these data, Kaplan and colleagues say that risk adjustment is necessary when studying postoperative analyses in patients with IBD.

Most importantly, the data will help clinicians stratify patients at highest risk for poor outcomes following surgery in patients with IBD.

By MedWire Reporters

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