Surgery for Ulcerative Colitis Is Associated with a High Rate of Readmissions at 30 Days

被引：20

作者：

Feuerstein, Joseph D. ^{[1
,2
]}

Jiang, Zhenghui G. ^{[1
,2
]}

Belkin, Edward ^{[3
]}

Lewandowski, Jeffrey J. ^{[4
]}

Martinez-Vazquez, Manuel ^{[5
]}

Singla, Anand ^{[6
,7
]}

Cataldo, Thomas ^{[8
,9
]}

Poylin, Vitaliy ^{[8
,9
]}

Cheifetz, Adam S. ^{[1
,2
]}

机构：

[1] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[2] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Div Gastroenterol, Boston, MA 02215 USA

[3] Univ Massachusetts, Sch Med, Dept Med, Mem Med Ctr, Worcester, MA USA

[4] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA 02215 USA

[5] Dr Jose Eleuterio Gonzalez Univ Hosp, Gastroenterol Serv, Monterrey, Mexico

[6] Univ Washington, Sch Med, Dept Med, Seattle, WA 98195 USA

[7] Univ Washington, Sch Med, Div Gastroenterol, Seattle, WA USA

[8] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Dept Surg, Boston, MA 02215 USA

[9] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Div Colorectal Surg, Boston, MA 02215 USA

来源：

INFLAMMATORY BOWEL DISEASES | 2015年 / 21卷 / 09期

关键词：

INFLAMMATORY-BOWEL-DISEASE; CROHNS-DISEASE; OUTCOMES; ADULTS;

D O I：

10.1097/MIB.0000000000000473

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Currently, the predictors of readmission after colectomy specifically for ulcerative colitis (UC) are poorly investigated. We sought to determine the rates and predictors of 30-day readmissions after colectomy for UC. Methods: Patients undergoing total proctocolectomy and end ileostomy, abdominal colectomy with end ileostomy, proctocolectomy with ileoanal pouch anastomosis (IPAA) formation and diverting ileostomy, one stage IPAA, or abdominal colectomy with ileorectal anastomosis at a tertiary care center between January 2002 and January 2012 for UC were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed. The electronic record system was reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for readmissions within 30 days of surgery. Univariate and multivariate analyses were performed using Stata v.13. Results: Two hundred nine patients with UC underwent a colectomy. Forty-three percent had a proctocolectomy with IPAA and diverting ileostomy and 32% had abdominal colectomy with end ileostomy. Seventy-six percent of surgeries were due to failure of medical therapy and 68% of patients were electively admitted for surgery. Thirty-two percent (n = 67/209) of the cohort was unexpectedly readmitted within 30 days. In multivariate model, proctocolectomy with IPAA and diverting ileostomy (odds ratio [OR] = 2.11; 95% CI, 1.06-4.19; P = 0.033) was the only significant predictor of readmission. Hospital length of stay >7 days (OR = 1.82; 95% CI, 0.98-3.41; P = 0.060), presence of limited UC (OR = 2.10; 95% CI, 0.93-4.74; P = 0.074), and steroid before admission (OR = 1.69; 95% CI, 0.90-3.2; P = 0.100) trended toward significance. Conclusions: Surgery for UC is associated with a high rate of readmission. Further prospective studies are necessary to determine the means to reduce these readmissions.

引用

页码：2130 / 2136

页数：7

共 17 条

[1] Corticosteroids and immunomodulators: Postoperative infectious complication risk in inflammatory bowel disease patients [J].