CHARLOTTE, N.C.—Having limited functional status, malnutrition, sepsis and emergency surgery are among the preoperative factors associated with increased odds of post–bowel resection adverse events among IBD patients, according to results of a retrospective cohort study presented at 2022 annual meeting of the American College of Gastroenterology.

Given that many IBD patients require surgery and that they are likely to have postoperative complications—particularly if they are older—researchers at NYU Langone Medical Center, in New York City, led by Adam S. Faye, MD, MS, and Cristina Fernandez, MD, MPH, sought to elucidate risk factors for these adverse events. The team used data from the American College of Surgeons National Surgical Quality Improvement Program database to quantify associations between various patient-level demographic, nutritional and clinical factors and risk for complications among patients at least 60 years of age who received IBD-related intestinal resection between 2005 and 2019.

Of 9,640 resections identified, surgery was performed more often in patients with ulcerative colitis (51.7%) than in those with Crohn’s disease. Overall, 37% of patients experienced a notable complication (e.g., mortality, hospital readmission, unplanned reoperation, infection, etc). Patients with CD were more likely than those with UC to have a complication (adjusted odds ratio [aOR], 1.22; 95% CI, 1.09-1.36). (The multivariable analysis included age, sex, race, IBD subtype, preoperative serum albumin, BMI, current smoking status, number of comorbidities, functional health status, malnutrition, sepsis within 48 hours prior to surgery, and whether or not the surgery was an emergency case.)

Additional factors associated with an increased odds of postoperative complications included:

• partially dependent functional health status (vs. independent; aOR, 7.28; 95% CI, 3.14-21.20);
• sepsis in 48 hours pre-surgery (aOR, 2.18; 95% CI, 1.78-2.67);
• preoperative serum albumin level of less than 3 (vs. 3-3.5; aOR, 1.99; 95% CI, 1.69-2.33);
• totally dependent functional health status (vs. independent; aOR, 1.72; 95% CI, 1.28-2.32);
• emergency surgery (vs. elective; aOR, 1.70; 95% CI, 1.36-2.11);
• two or more comorbidities (vs. 0 to 1; aOR, 1.50; 95% CI, 1.27-1.76);
• malnourishment (>10% loss of body weight in six months before surgery; aOR, 1.23; 95% CI, 1.03-1.48); and
• BMI of greater than 30 kg/m² (vs. 18.5-25 kg/m²; aOR, 1.20; 95% CI, 1.04-1.40).

Given the increased risk for complications among patients who undergo emergency versus elective surgery, the research team also examined trends in the proportion of these surgeries in these older IBD patients. They found no significant reduction between 2005 and 2019 for IBD overall or for UC or CD alone.

Considering their findings, the researchers emphasized the need for future research on “preoperative rehabilitation, nutritional optimization and timely surgery to improve outcomes.” Dr. Fernandez told Gastroenterology & Endoscopy News that “this is an area that still needs to be explored further, especially in this population” of older adults with IBD. She noted that there is a general lack of data that makes it difficult for specific recommendations to be made that can prevent complications in older adults. “This is what our next study is going to be on: Now that we have this information, how can we improve outcomes?”

In the meantime, the information about risk factors from the current study could be useful. For example, more timely surgery can reduce the risk for preoperative sepsis or need for emergency surgery. Furthermore, Drs. Faye and Fernandez noted that “if a patient has limited functional status and/or is malnourished, working with a team (e.g., geriatrician, a nutritionist and a physical therapist) may help improve these conditions preoperatively and lead to improved postoperative outcomes.”

Emphasizing the importance of research in this patient population “that will increasingly become a part of our IBD practices,” Ashwin Ananthakrishnan, MBBS, MPH, a gastroenterologist at Massachusetts General Hospital’s Crohn’s and Colitis Center, who was not involved in the study, said it “provides some potentially modifiable targets, including functional status, most importantly, but also timing of surgery and comorbidity,” all of which he noted are critical to “[optimize] prior to surgery.”

Building on Dr. Fernandez’s vision for future research, Dr. Ananthakrishnan underscored the need for “systematic interventions targeting these modifiable factors particularly for elective operations in older adults.”

—Natasha Albaneze

Drs. Ananthakrishnan and Fernandez reported no relevant financial disclosures. Dr. Faye reported a financial relationship with Janssen.