Postoperative mortality in inflammatory bowel disease patients

Ropelato, Renato Vismara; Kotze, Paulo Gustavo; Froehner, Ilário; Dadan, Danieli D.; Miranda, Eron Fábio

doi:10.1016/j.jcol.2017.01.001

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Journal of Coloproctology (Rio de Janeiro)

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Sumário

Original Articles • J. Coloproctol. (Rio J.) 37 (2) • Apr-Jun 2017 • https://doi.org/10.1016/j.jcol.2017.01.001 copy

Postoperative mortality in inflammatory bowel disease patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Since the 1960s, mortality in Crohn's disease and Ulcerative Colitis patients had a significant decrease due to advances in medical and surgical therapy. An important proportion of these patients are submitted to surgical procedures during their disease course, with postoperative mortality between 4 and 10%.

Methods:

157 inflammatory bowel disease patients submitted to surgical therapy were retrospectively identified and allocated in 2 groups (Crohn's and colitis). Deaths were individually discriminated in detail.

Results:

281 surgical procedures were performed. In the colitis group, 43 operations were performed in 24 patients; in the abdominal Crohn's subgroup, 127 procedures in 90 patients and in the perineal Crohn's subgroup, 115 in 64 patients, respectively. Nine postoperative deaths were observed (3 in the colitis and 6 in the Crohn's groups). Overall postoperative mortality was 5.7% (4.5% for Crohn's; 6.6% in abdominal Crohn's and 12.5% for Colitis). Most of deaths were related to emergency procedures and previous use of corticosteroids. The cause of death in all patients was sepsis.

Conclusions:

Overall postoperative mortality in inflammatory bowel disease was 5.7%, and it was attributed to the severity of the cases referred.

Keywords:
Mortality; Crohn's disease; Ulcerative colitis; Surgery

	Crohn's disease (CD)		Ulcerative colitis (UC)		Total
	Male	Female	Male	Female
Patients (n)	75	58	15	9	157
Surgical procedures (n)	135	104	27	16	281
Mean age	34.2 (12-65)	41.5 (15-82)	37.7 (19-76)	40.6 (14-64)	36.2 (12-82)

Surgical procedures performed	Elective	Emergency	Total
Total colectomy with terminal ileostomy	2	9	11
Total proctocolectomy with ileal pouch	6	0	6
Total proctocolectomy with end ileostomy	4	0	4
Proctectomy	3	0	3
Right colectomy	2	0	2
Total colectomy with ileorectal anastomosis	1	0	1
Enteroanastomosis	8	0	8
Laparotomy for abdominal collection drainage	0	3	3
Laparotomy for lysis of adhesions	0	2	2
Abscess drainage by perineal route	0	1	1
Peristomal abscess drainage	0	1	1
Abdominal wall reconstruction	0	1	1

Total	26	17	43

Surgeries performed	Elective	Emergency	Total
Enterectomy and/or stenoplasty	39	3	42
Right Ileocolectomy	32	2	34
Right Ileocolectomy with Enterectomy	22	0	22
Left colectomy	5	0	5
Total colectomy with end ileostomy	3	2	5
Total proctocolectomy with end ileostomy	3	0	3
Proctectomy	2	0	2
Enteroanastomosis	6	0	6
Ileostomy	4	4	8
Loop colostomy	0	2	2
Colorraphy	4	0	4
Exploratory laparotomy	0	11	11
Urological procedures	3	3	6
Reconstruction of the abdominal wall	0	3	3
Peritoniostomy	0	3	3
Incisional herniorraphy	1	0	1
Oophorectomy	1	0	1

Total	126	32	158

	Patients	Operations	Deaths	Mortality (%)
				Patients	Operations
General	157	281	9	5.7	3.2
Crohn's (abdominal subgroup)	90	127	6	6.6	4.7
Crohn's (perineal subgroup)	64	115	0	0	0
UC	24	43	3	12.5	6.9

Previous treatments
		Gender	Age	AZA	MSZ	CTC	Anti-TNF-α	Surgeries	Malnutrition/TPN	Anemia/Transfusion	Surgery performed (initial)	Indication	Emergency	POHT (days)	Surgeries (n)	Causa mortis
CD	1	M	38	Yes	No	No	No	Enterectomy	Yes/Yes	Yes/Yes	Enterorraphies and ileostomy	Enterocutaneous fistulas	Yes	11	4	Abdominal sepsis
	2	M	31	Yes	No	Yes	No	No	Yes/Yes	Yes/No	Debridement	Fournier's Sd.	Yes	0	6	Fournier's Sd.
	3	F	77	Yes	Yes	No	No	No	Yes/Yes	Yes/Yes	Right ileocolectomy and enterectomy	Enterocutaneous fistulas	Yes	4	2	Pulmonary sepsis
	4	M	44	Yes	No	Yes	No	Right ileocolectomy	Yes/Yes	Yes/Yes	Right ileocolectomy	Intestinal occlusion	Yes	1	2	Pulmonary sepsis
	5	M	18	No	No	Yes	No	Perianal abscess drainage	Yes/Yes	Yes/Yes	Total colectomy with end ileostomy	Colon perforation + LDH	Yes	0	6	Central venous catheter sepsis
	6	F	20	Yes	No	Yes	Yes (ADA)	Two-stage total colectomy and fistulotomy	Yes/Yes	Yes/Yes	Two-stage enterectomy and fistulotomy	Enterocutaneous fistulas	Yes	2	3	Central venous catheter sepsis

NSUC	7	F	18	Yes	Yes	Yes	No	No	Yes/Yes	Yes/Yes	Total colectomy with end ileostomy	Intractability - hemorrhage	Yes	17	1	Fungal sepsis
	8	F	14	Yes	Yes	Yes	Yes (IFX)	No	Yes/Yes	Yes/Yes	Total colectomy with end ileostomy	Intractability - perforation	Yes	3	2	Pulmonary sepsis
	9	M	76	No	No	Yes	No	No	Yes/No	Yes/Yes	Total colectomy with end ileostomy	Intractability - toxic megacolon	Yes	1	1	Pulmonary sepsis

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E-mail: sbcp@sbcp.org.br

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[1] *Corresponding author. E-mail: renavropelato@hotmail.com (R.V. Ropelato).