HHS Public Access Author manuscript Author Manuscript
Gastroenterology. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Gastroenterology. 2016 November ; 151(5): 1029–1030. doi:10.1053/j.gastro.2016.09.027.
Operate or Medicate: Understanding Surgical Risks in the Elderly with Inflammatory Bowel Disease MARC S. PIPER, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Author Manuscript
AKBAR K. WALJEE, and VA Ann Arbor Health Services, Research & Development Center for Clinical Management Research, Ann Arbor, Michigan RYAN W. STIDHAM Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Author Manuscript
Inflammatory bowel disease (IBD) does not discriminate by race, gender, or age. Modern advances in medical care and public health have resulted in improvements in life expectancy. The population of elderly patients with IBD is increasing dramatically. Aging is accompanied by changes in in organ physiology, pharmacokinetics and dynamics, polypharmacy and potential drug interactions, as well as susceptibility to disability. There is an increasing need to better understand how age-related factors impact disease behavior and clinical outcomes among elderly IBD patients. Beyond their response and tolerance to medications, many questions also arise when considering surgical management in the elderly.
Author Manuscript
Bollegala et al used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset to examine differences in IBD-surgical outcomes within an elderly population (Clin Gastroenterol Hepatol 2016;14:1274–1281). The ACS-NSQIP is national data repository involving 648 participating hospitals, containing validated 30-day risk-adjusted surgical outcome data collected by trained reviewers using source medical records. Defining elderly as ≥65 years of age, the authors identified 15,495 IBD-related surgeries between 2005 and 2012, of which 1,707 (11%) met the elderly criterion. The primary study outcome was 30-day mortality, with secondary outcomes of nonlethal adverse events, wound infection and dehiscence, and health care resource use. Estimates of outcome differences by elderly status were adjusted to other key covariates by traditional logistic regression. The study results revealed that the odds of 30-day postoperative mortality in the elderly was 4.4-fold greater in ulcerative colitis (6.1% vs 0.7%) and 11.7-fold greater in Crohn’s disease (CD; 4.2% vs 0.3%) compared with nonelderly IBD patients in the adjusted analysis. On sensitivity analysis, serum albumin levels were independently associated with 30-day mortality, with very low levels (
Gastroenterology. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Gastroenterology. 2016 November ; 151(5): 1029–1030. doi:10.1053/j.gastro.2016.09.027.
Operate or Medicate: Understanding Surgical Risks in the Elderly with Inflammatory Bowel Disease MARC S. PIPER, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Author Manuscript
AKBAR K. WALJEE, and VA Ann Arbor Health Services, Research & Development Center for Clinical Management Research, Ann Arbor, Michigan RYAN W. STIDHAM Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Author Manuscript
Inflammatory bowel disease (IBD) does not discriminate by race, gender, or age. Modern advances in medical care and public health have resulted in improvements in life expectancy. The population of elderly patients with IBD is increasing dramatically. Aging is accompanied by changes in in organ physiology, pharmacokinetics and dynamics, polypharmacy and potential drug interactions, as well as susceptibility to disability. There is an increasing need to better understand how age-related factors impact disease behavior and clinical outcomes among elderly IBD patients. Beyond their response and tolerance to medications, many questions also arise when considering surgical management in the elderly.
Author Manuscript
Bollegala et al used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset to examine differences in IBD-surgical outcomes within an elderly population (Clin Gastroenterol Hepatol 2016;14:1274–1281). The ACS-NSQIP is national data repository involving 648 participating hospitals, containing validated 30-day risk-adjusted surgical outcome data collected by trained reviewers using source medical records. Defining elderly as ≥65 years of age, the authors identified 15,495 IBD-related surgeries between 2005 and 2012, of which 1,707 (11%) met the elderly criterion. The primary study outcome was 30-day mortality, with secondary outcomes of nonlethal adverse events, wound infection and dehiscence, and health care resource use. Estimates of outcome differences by elderly status were adjusted to other key covariates by traditional logistic regression. The study results revealed that the odds of 30-day postoperative mortality in the elderly was 4.4-fold greater in ulcerative colitis (6.1% vs 0.7%) and 11.7-fold greater in Crohn’s disease (CD; 4.2% vs 0.3%) compared with nonelderly IBD patients in the adjusted analysis. On sensitivity analysis, serum albumin levels were independently associated with 30-day mortality, with very low levels (
