A0330 - Preoperative Risk Factors of Adverse Events in Older Adults Undergoing Bowel Resection for Inflammatory Bowel Disease: 15-Year Assessment of ACS-NSQIP

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Cristina Fernandez, MD, MPH

NYU Langone Health
New York, NY

Cristina Fernandez, MD, MPH, Zoran Gajic, BS, Eren Esen, MD, MS, John Dodson, MD, MPH, Joshua Chodosh, MD, Aasma Shaukat, MD, MPH, David Hudesman, MD, Feza Remzi, MD, Adam Faye, MD, MS
NYU Langone Health, New York, NY

Introduction: Nearly a quarter of older adults with inflammatory bowel disease (IBD) require surgery. Patients with IBD are at risk for complications postoperatively and this risk is increased in older adults. However, little is known about the risk factors leading to these complications. We assessed risk factors associated with adverse postoperative outcomes among older adults who underwent IBD-related surgery, as well as evaluated trends in emergency vs. elective surgery in this population.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified adults ≥60 years of age who underwent an IBD-related intestinal resection from 2005-2019. Our primary outcome included a 30-day composite of mortality, readmission, reoperation, and/or what we identified as serious complications listed in NSQIP.

Results: In total, 9,640 intestinal resections were performed among older adults with IBD from 2005-2019, with 48.3% having undergone resection for Crohn’s disease (CD), and 51.7% for ulcerative colitis (UC). Nearly 37% experienced an adverse outcome, with the most common complication being infection (20.21%). From 2005 to 2015, there was no decrease in the number of emergent cases among older adults. On univariate analysis, higher rates of adverse postoperative outcomes were seen with increasing age (p< 0.001), with nearly 50% of those ≥80 years of age having an adverse outcome. Patients who underwent an emergency surgery had a higher likelihood of postoperative complications (66.86%; p< 0.001). On multivariable analysis, albumin ≤3 (aOR 1.99; 95%CI 1.69-2.33), the presence of two or more comorbidities (aOR, 1.50; 95%CI 1.27-1.76), totally dependent functional status as compared to those partially dependent or independent (aOR, 7.28; 95%CI 3.14-21.2), and emergency surgery (aOR, 1.70; 95%CI 1.36-2.11) significantly increased the odds of an adverse outcome.

Discussion: Overall 37% of older adults with IBD experienced an adverse outcome as a result of IBD-related surgery. Limited functional health status, low preoperative serum albumin levels, and those undergoing emergent surgery were associated with a significantly higher risk. This is particularly important as the number of older adults with IBD is increasing, with a persisting number of emergency cases over time. Given the high rate of surgery in this population, future research should focus on preoperative rehabilitation, nutritional optimization, and timely surgery to improve outcomes.

Figure: Emergency trends between 2005-2015 according to ACS-NSQIP stratified by IBD subtype

Characteristics	Adjusted OR^a (95% CI)	p-value
Age (years)
60-70	Ref	-
70-80	1.01 (0.89-1.14)	0.882
≥80	1.02 (0.81-1.29)	0.845
Sex
Male	Ref	-
Female	1.03 (0.92-1.15)	0.559
Race
Asian/Hawaiian	Ref	-
Non-Hispanic Black	1.14 (0.66-2.01)	0.641
Non-Hispanic White	1.19 (0.73-2.00)	0.494
Other	1.56 (0.58-4.13)	0.369
IBD^b
UC	Ref	-
CD	1.22 (1.09-1.36)	< 0.001
Preoperative Serum Albumin
0-3	1.99 (1.69-2.33)	< 0.001
3-3.5	Ref	-
3.5-10	0.69 (0.6-0.8)	< 0.001
BMI^c
0-18.5	0.81 (0.63-1.05)	0.11
18.5-25	Ref	-
25-30	1.03 (0.9-1.17)	0.667
30+	1.2 (1.04-1.4)	< 0.05
Current Smoker^d
No	Ref	-
Yes	0.9 (0.76-1.07)	0.256
Comorbidities^e
0-1	Ref	-
1-2	1.15 (1.02-1.3)	< 0.05
2-7	1.5 (1.27-1.76)	< 0.001
Functional Health Status
Independent	Ref	-
Partially Dependent	1.72 (1.28-2.32)	< 0.001
Totally Dependent	7.28 (3.14-21.2)	< 0.001
Malnourishment^f
No	Ref	-
Yes	1.23 (1.03-1.48)	< 0.05
Sepsis within 48 hours prior to surgery
No	Ref	-
Yes	2.18 (1.78-2.67)	< 0.001
Emergency Case
No	Ref	-
Yes	1.7 (1.36-2.11)	< 0.001

aOdds Ratio; bInflammatory Bowel Disease; cBody Mass Index; dCurrent smoker within one year; eHypertension Requiring Medication + history of severe COPD + ascites within 30 days prior to surgery + CHF in 30 days before surgery + Diabetes Mellitus Requiring Therapy with Non-Insulin Agents or Insulin + CKD + disseminated cancer; f>10% Loss of Body Weight in the 6 Months Prior to Surgery

Table: Adjusted Odds between Preoperative Characteristics and Poor Postoperative Outcomes among Older Adults with IBD who Underwent IBD-Related Bowel Resection from 2005-2019

Disclosures:

Cristina Fernandez indicated no relevant financial relationships.

Zoran Gajic indicated no relevant financial relationships.

Eren Esen indicated no relevant financial relationships.

John Dodson indicated no relevant financial relationships.

Joshua Chodosh indicated no relevant financial relationships.

Aasma Shaukat indicated no relevant financial relationships.

David Hudesman: Abbvie – Consultant. Bristol Myers Squibb – Consultant. Janssen – Consultant, Grant/Research Support. Pfizer – Consultant, Grant/Research Support. Takeda – Consultant.

Feza Remzi indicated no relevant financial relationships.

Adam Faye: GLG – Consultant. Guidepoint – Consultant. Janssen – Consultant. LEK – Consultant. M3 Consulting – Consultant.

Cristina Fernandez, MD, MPH, Zoran Gajic, BS, Eren Esen, MD, MS, John Dodson, MD, MPH, Joshua Chodosh, MD, Aasma Shaukat, MD, MPH, David Hudesman, MD, Feza Remzi, MD, Adam Faye, MD, MS. A0330 - Preoperative Risk Factors of Adverse Events in Older Adults Undergoing Bowel Resection for Inflammatory Bowel Disease: 15-Year Assessment of ACS-NSQIP, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.