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DOP045 Post-operative complications in elderly-onset inflammatory bowel disease: a population-based study

Sacleux S.-c.*1, Charpentier C.1, Sarter H.2, Fumery M.3, Guillon-Dellac N.4, Laberenne E.5, Pariente B.6, Peyrin-biroulet L.7, Gower-Rousseau C.8, Savoye G.1

1CHU Rouen, Department of Gastroenterology and Hepatology, Rouen, France 2CHRU Lille, Department of Biostatistics EA 2694, Lille, France 3Amiens University Hospital, Department of Gastroenterology and Hepatology, Amiens, France 4CHRU Lille, Department of Epidemiology, Lille, France 5CH Seclin, Department of Gastroenterology, Seclin, France 6CHRU Lille, Department of Gastroenterology, Lille, France 7CHU Nancy, Department of Gastroenterology and Hepatology, Vandoeuvre-Lès-Nancy, France 8CHRU Lille, Department of Epidemiology, EPIMAD Registry, Lille, France

Background

Inflammatory Bowel Diseases (IBD) diagnosed after the age of 60 are increasing. Surgical rates are similar to those in the younger population. Post-operative complications (POC) in elderly-onset IBD have never been investigated at the population level. We reported the incidence and factors associated with POC in a well-defined population-based registry.

Methods

Among 841 elderly-onset IBD patients from the EPIMAD registry (1), 139 (16.5%) patients underwent surgery: 100 had Crohn's Diseases (CD) and 39 ulcerative colitis (UC). Medical charts for early (≤30 days of surgery) and late (>30 days of surgery) POC were reviewed using the Dindo's classification (2). Associated factors were analyzed by logistic regression for early POC and Cox regression models for late POC.

Results

After a median follow-up of 7.3 years [Q1=3-Q3=12], 50 patients (50/139, 36.0%) had at least one POC (n=69), without significant difference between UC and CD. Thirty-two early POC were observed in 23 of 50 patients; 48% of POC (15/32) were infectious and 52% of patients (12/23) had severe POC (defined by a Dindo's grade >2). Six (6/23, 26%) patients died because of early POC. Among the 37 late complications observed in 33 patients, 56% of POC (20/37) were mechanical (bridle, eventration, anastomotic stricture) and 42% of patients (15/33) had severe POC. The cumulative probability of late POC was 10.9% at 1 year (6.5–18.1), 22.8% at 5 years (16.0–32.0) and 30.5% (21.8–41.4) at 10 years. In multivariate analysis, emergency surgery (HR=4.46 [1.75–11.36]) and acute severe ulcerative colitis (HR=7.84 [2.15–28.52]) were significantly associated with early POC. Female gender (HR=2.10 [1.01–4.37]) and time between diagnosis and surgery >3 months (HR=2.09 [1.01–4.31]) were significantly associated with late POC.

Conclusion

In elderly-onset IBD patients who underwent surgery, POC were frequent and half of them were severe. Emergency surgery and acute severe ulcerative colitis were significantly associated with early complications, while female gender and delay between diagnosis and surgery were associated with late POC. These results reinforce the need for specialized and dedicated management of elderly patients undergoing surgery.

References:

[1] Charpentier et al. Gut 2014

[2] Dindo et al. Ann. Surg. 2004