Vasantham Chaudhary, Frank R Chung, Olivia Delau, Bari Dane, Irving Levine, Xucong Meng, Joshua Chodosh, Andre da Luz Moreira, Jessica N Simon, Jordan E Axelrad, Seymour Katz, John Dodson, Aasma Shaukat, Adam S Faye
{"title":"炎症性肠病患者手术前一年营养不良的风险增加。","authors":"Vasantham Chaudhary, Frank R Chung, Olivia Delau, Bari Dane, Irving Levine, Xucong Meng, Joshua Chodosh, Andre da Luz Moreira, Jessica N Simon, Jordan E Axelrad, Seymour Katz, John Dodson, Aasma Shaukat, Adam S Faye","doi":"10.1177/17562848251365036","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In patients with inflammatory bowel disease (IBD) who need intestinal resection, prior data suggest that earlier surgical intervention may be associated with improved outcomes. However, surgery is often deferred for additional trials of advanced therapies, which potentially shifts patients from a fit to a frail preoperative state.</p><p><strong>Objectives: </strong>This study aimed to evaluate clinical changes that occur in the year prior to intestinal resection in patients with IBD.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>This was a multi-hospital retrospective study of patients ⩾18 years old who underwent initial IBD-related intestinal resection between January 1, 2018 and May 31, 2023. Clinical characteristics and radiographical skeletal muscle mass were compared using the Wilcoxon Signed-Rank test for continuous variables and McNemar's test for categorical variables.</p><p><strong>Results: </strong>A total of 170 patients were included (120 with Crohn's disease, 40 with ulcerative colitis, and 10 with indeterminate colitis), with a median disease duration of 7.4 years (interquartile range (IQR) 3.3-13.8). Median age at surgery was 32.6 years (IQR 25.9-44.9), and 51% were female. In the month prior to surgery as compared to the 6-12 months prior, individuals were more likely to have an IBD-related hospitalization (31% vs 5%, <i>p</i> < 0.01), malnutrition (30% vs 18%, <i>p</i> < 0.01), or an infection (74% vs 28%, <i>p</i> < 0.01). Though not statistically significant, there was an increase in the proportion of individuals who developed a venous thromboembolism in the month prior to surgery, and a decrease in skeletal muscle mass among those with two computerized tomography scans in the year prior to surgery (<i>n</i> = 6, 126 vs 111 cm2; <i>p</i> = 0.06).</p><p><strong>Conclusion: </strong>In the 6-12 months prior to an IBD-related intestinal resection, as compared to the month prior, individuals were less likely to be malnourished, have an infection, or need hospitalization for IBD. 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However, surgery is often deferred for additional trials of advanced therapies, which potentially shifts patients from a fit to a frail preoperative state.</p><p><strong>Objectives: </strong>This study aimed to evaluate clinical changes that occur in the year prior to intestinal resection in patients with IBD.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>This was a multi-hospital retrospective study of patients ⩾18 years old who underwent initial IBD-related intestinal resection between January 1, 2018 and May 31, 2023. Clinical characteristics and radiographical skeletal muscle mass were compared using the Wilcoxon Signed-Rank test for continuous variables and McNemar's test for categorical variables.</p><p><strong>Results: </strong>A total of 170 patients were included (120 with Crohn's disease, 40 with ulcerative colitis, and 10 with indeterminate colitis), with a median disease duration of 7.4 years (interquartile range (IQR) 3.3-13.8). Median age at surgery was 32.6 years (IQR 25.9-44.9), and 51% were female. In the month prior to surgery as compared to the 6-12 months prior, individuals were more likely to have an IBD-related hospitalization (31% vs 5%, <i>p</i> < 0.01), malnutrition (30% vs 18%, <i>p</i> < 0.01), or an infection (74% vs 28%, <i>p</i> < 0.01). Though not statistically significant, there was an increase in the proportion of individuals who developed a venous thromboembolism in the month prior to surgery, and a decrease in skeletal muscle mass among those with two computerized tomography scans in the year prior to surgery (<i>n</i> = 6, 126 vs 111 cm2; <i>p</i> = 0.06).</p><p><strong>Conclusion: </strong>In the 6-12 months prior to an IBD-related intestinal resection, as compared to the month prior, individuals were less likely to be malnourished, have an infection, or need hospitalization for IBD. 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引用次数: 0
摘要
背景：在需要肠切除术的炎症性肠病（IBD）患者中，先前的数据表明，早期手术干预可能与改善预后有关。然而，手术常常被推迟，以进行更多的先进疗法试验，这可能会使患者从健康状态转移到虚弱的术前状态。目的：本研究旨在评估IBD患者肠切除术前一年发生的临床变化。设计：回顾性队列研究。方法：这是一项针对在2018年1月1日至2023年5月31日期间接受了初始ibd相关肠道切除术的未满18岁患者的多医院回顾性研究。使用连续变量的Wilcoxon Signed-Rank检验和分类变量的McNemar检验比较临床特征和x线片骨骼肌质量。结果：共纳入170例患者（克罗恩病120例，溃疡性结肠炎40例，不确定结肠炎10例），中位病程7.4年（四分位间距（IQR） 3.3-13.8）。手术年龄中位数为32.6岁（IQR 25.9-44.9）， 51%为女性。术前1个月与术前6-12个月相比，个体更有可能出现ibd相关住院（31% vs 5%, p p p n = 6, 126 vs 111 cm2; p = 0.06）。结论：在IBD相关肠道切除术前6-12个月，与前一个月相比，个体营养不良、感染或因IBD住院的可能性较低。这表明尽量减少手术延误可能会改善预后。
Risk of malnutrition increases in the year prior to surgery among patients with inflammatory bowel disease.
Background: In patients with inflammatory bowel disease (IBD) who need intestinal resection, prior data suggest that earlier surgical intervention may be associated with improved outcomes. However, surgery is often deferred for additional trials of advanced therapies, which potentially shifts patients from a fit to a frail preoperative state.
Objectives: This study aimed to evaluate clinical changes that occur in the year prior to intestinal resection in patients with IBD.
Design: Retrospective cohort study.
Methods: This was a multi-hospital retrospective study of patients ⩾18 years old who underwent initial IBD-related intestinal resection between January 1, 2018 and May 31, 2023. Clinical characteristics and radiographical skeletal muscle mass were compared using the Wilcoxon Signed-Rank test for continuous variables and McNemar's test for categorical variables.
Results: A total of 170 patients were included (120 with Crohn's disease, 40 with ulcerative colitis, and 10 with indeterminate colitis), with a median disease duration of 7.4 years (interquartile range (IQR) 3.3-13.8). Median age at surgery was 32.6 years (IQR 25.9-44.9), and 51% were female. In the month prior to surgery as compared to the 6-12 months prior, individuals were more likely to have an IBD-related hospitalization (31% vs 5%, p < 0.01), malnutrition (30% vs 18%, p < 0.01), or an infection (74% vs 28%, p < 0.01). Though not statistically significant, there was an increase in the proportion of individuals who developed a venous thromboembolism in the month prior to surgery, and a decrease in skeletal muscle mass among those with two computerized tomography scans in the year prior to surgery (n = 6, 126 vs 111 cm2; p = 0.06).
Conclusion: In the 6-12 months prior to an IBD-related intestinal resection, as compared to the month prior, individuals were less likely to be malnourished, have an infection, or need hospitalization for IBD. This suggests that minimizing delays to surgery may lead to improved outcomes.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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