接受手术的老年炎症性肠病患者的新手术和医院诊断感染--一项全国性队列研究

Bente Mertz Nørgård, Olav Sivertsen Garvik, Floor Dijkstra Zegers, Jan Nielsen, Ken Lund, Torben Knudsen, Jens Kjeldsen
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摘要

背景 患有炎症性肠病(IBD)的老年患者在很多方面都很脆弱。因此,我们对这些患者的术后并发症(首次 IBD 手术后新的腹部手术和严重感染)进行了研究。方法 这是一项基于丹麦健康登记的全国性队列研究,研究对象包括接受手术的 IBD 患者。研究人群分为溃疡性结肠炎(UC)和克罗恩病(CD)。暴露人群(老年人)包括首次接受 IBD 手术时年龄≥ 60 岁的患者,未暴露人群(成年人)包括 18-59 岁时接受手术的患者。我们估算了 a) 2 年内新的腹部手术和 b) 6 个月和 12 个月内严重(医院诊断的)感染的调整后危险比 (aHR)。我们对几种混杂因素进行了调整,包括指数手术的类型(腹腔镜手术或开腹手术)。结果 患有 UC 和 CD 的老年人接受新手术的 aHR 分别为 0.69 (95% CI 0.58-0.83) 和 0.98 (95% CI 0.83-1.15)。在患有 UC 的老年人中,术后 6 个月和 12 个月内感染的 aHR 分别为 1.07(95% CI 0.81-1.40)和 0.85(95% CI 0.67-1.08)。在患有 CD 的老年人中,6 个月和 12 个月内感染的 aHRs 分别为 1.45 (95% CI 1.12-1.88) 和 1.26 (95% CI 1.00-1.59)。结论 患有 IBD 的老年人在首次手术后两年内再次接受腹部手术的风险并没有增加。患有 CD(而非 UC)的老年人在手术后 6 个月内发生严重感染的风险增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
New surgery and hospital-diagnosed infections in elderly patients with inflammatory bowel disease undergoing surgery - a nationwide cohort study
Background Elderly patients with inflammatory bowel disease (IBD) are fragile in many aspects. Therefore, in these patients, we studied post-operative complications (new abdominal surgery and serious infections after the first IBD surgery). Methods This is a nationwide cohort study based on Danish health registries and included patients with IBD undergoing surgery. The study population was split into ulcerative colitis (UC) and Crohn’s disease (CD). The exposed cohort (elderly) constituted those at an age of ≥ 60 years at first IBD surgery, and the unexposed (adults) those with surgery at the age of 18-59 years. We estimated adjusted Hazard Ratios (aHR) of a) new abdominal surgery within 2 years, and b) serious (hospital-diagnosed) infections within 6 and 12 months. We adjusted for several confounders including type of index surgery (laparoscopic or open). Results The aHR for a new surgery among elderly with UC and CD were 0.69 (95% CI 0.58-0.83) and 0.98 (95% CI 0.83-1.15), respectively. In elderly with UC, the aHRs of infections within 6 and 12 months after surgery were 1.07 (95% CI 0.81- 1.40) and 0.85 (95% CI 0.67-1.08), respectively. In the elderly with CD, the aHRs of infections within 6 and 12 months were 1.45 (95% CI 1.12-1.88) and 1.26 (95% CI 1.00-1.59), respectively. Conclusion The elderly with IBD did not have an increased risk of new abdominal surgery within two years of the first surgery. Elderly with CD, but not UC, had an increased risk of serious infections within 6 months of surgery.
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