EDs Are No Place For IBS Surgery

Better management of patients with ulcerative colitis and Crohn’s disease could possibly lead to cost savings and certainly better outcomes, according to a study in Gastroenterology. Intestinal resection surgery for these inflammatory bowel diseases ensured a much better survival rate than surgery given in emergency departments (EDs), according to researchers at the University of Calgary.

The overall mortality rate for ulcerative colitis and Crohn’s disease patients who got surgery in the ED was 5.3% and 3.6%, respectively, according to this meta-analysis. (The study periods varied so it can’t be said over what period of time those deaths occurred.) For patients getting elective surgery, the mortality rate was under 1%.

“These data can be used by patients with IBD and clinicians to understand the risk of death after an intestinal resection,” the study states. “This knowledge can assist with disease counseling and treatment planning.”

Emergency surgeries are often performed by less experienced physicians and can occur during off-hours and weekends, when fewer people are working, the study states.

“In addition, IBD patients who had unplanned surgeries after failing to respond to in-hospital medical management often had complications of preoperative illnesses (eg, venous thromboembolism or Clostridium difficile), received prolonged courses of intravenous corticosteroids, and suffered from malnutrition.”

The lower risk of elective surgery may in part be explained by the greater use of laparoscopic surgery. Laparoscopic surgery has better postoperative outcomes than open surgeries for IBD, the study states.

The meta-analysis could not adequately investigate the effects of preoperative medications for IBD management, such as anti-tumor necrosis factor (TNF) therapy. The anti-TNF drugs—which include infliximab (Remicade) and adalimumab (Humira)—may explain why the rates of emergency surgery for that condition “decreased significantly” between 1997 and 2010, the study states.

“Observational data have suggested that prescribing anti-TNF agents before the onset of a penetrating or obstructing complication decreases the need for surgery, and among those patients who require surgery the burden and extent of surgery may be reduced by preoperative treatment with anti-TNF therapies.”