Geoffrey C Nguyen1,2, Lillian Du1, Rachel Y Chong3, Timothy D Jackson1,4. 1. Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada. 2. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada. 3. Lakeridge Health, Department of Medicine, Queen's University, Oshawa, ON, Canada. 4. University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: The inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], frequently lead to bowel surgery. Hypoalbuminaemia has been shown to be a prognostic factor for outcomes following surgery for other indications, and we sought to determine its role in predicting IBD-related postoperative outcomes. METHODS: We included patients who underwent IBD-related major abdominal surgery in the American College of Surgeons' National Surgical Quality Improvement Program [ACS-NSQIP] between 2005 and 2012. We assessed the impact of indicators of protein-energy malnutrition [PEM] including hypoalbuminaemia, weight loss, and body mass index on postoperative outcomes. RESULTS: We identified 10 913 IBD patients [6082 Crohn's disease and 4831 ulcerative colitis] who underwent bowel surgery. The prevalence of modest and severe hypoalbuminaemia was 17% and 24%, respectively; 30-day mortality was higher in Crohn's patients with modest and severe hypoalbuminaemia compared with those with normal albumin levels preoperatively [0.7% vs 0.2%, p <0.05; 2.4% vs 0.2%, p <0.01]. The same was true for patients with UC with modest and severe hypoalbuminaemia [0.9% vs 0.1%, p <0.01; 5.6% vs 0.1%, p <0.01]. Overall infectious complications were more common in the presence of severe hypoalbuminaemia for CD [20% vs 13%, p <0.01]. and UC [28% vs 15%, p <0.01] patients. Last, there were higher rates of extra-intestinal, non-septic complications in both CD and UC patients with hypoalbuminaemia compared with those with normal albumin levels. CONCLUSIONS: This study suggests that moderate-severe hypoalbuminaemia is associated with worse IBD-related postoperative outcomes and may have a role in preoperative risk stratification.
BACKGROUND: The inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], frequently lead to bowel surgery. Hypoalbuminaemia has been shown to be a prognostic factor for outcomes following surgery for other indications, and we sought to determine its role in predicting IBD-related postoperative outcomes. METHODS: We included patients who underwent IBD-related major abdominal surgery in the American College of Surgeons' National Surgical Quality Improvement Program [ACS-NSQIP] between 2005 and 2012. We assessed the impact of indicators of protein-energy malnutrition [PEM] including hypoalbuminaemia, weight loss, and body mass index on postoperative outcomes. RESULTS: We identified 10 913 IBD patients [6082 Crohn's disease and 4831 ulcerative colitis] who underwent bowel surgery. The prevalence of modest and severe hypoalbuminaemia was 17% and 24%, respectively; 30-day mortality was higher in Crohn's patients with modest and severe hypoalbuminaemia compared with those with normal albumin levels preoperatively [0.7% vs 0.2%, p <0.05; 2.4% vs 0.2%, p <0.01]. The same was true for patients with UC with modest and severe hypoalbuminaemia [0.9% vs 0.1%, p <0.01; 5.6% vs 0.1%, p <0.01]. Overall infectious complications were more common in the presence of severe hypoalbuminaemia for CD [20% vs 13%, p <0.01]. and UC [28% vs 15%, p <0.01] patients. Last, there were higher rates of extra-intestinal, non-septic complications in both CD and UC patients with hypoalbuminaemia compared with those with normal albumin levels. CONCLUSIONS: This study suggests that moderate-severe hypoalbuminaemia is associated with worse IBD-related postoperative outcomes and may have a role in preoperative risk stratification.
Authors: J Daley; M G Forbes; G J Young; M P Charns; J O Gibbs; K Hur; W Henderson; S F Khuri Journal: J Am Coll Surg Date: 1997-10 Impact factor: 6.113
Authors: James R Irwin; Emma Ferguson; Lisa A Simms; Katherine Hanigan; James D Doecke; Daman Langguth; Ashley Arnott; Graham Radford-Smith Journal: Dig Dis Sci Date: 2018-11-26 Impact factor: 3.199
Authors: Pascal R Fuchshuber; William Greif; Chantal R Tidwell; Michael S Klemm; Cheryl Frydel; Abdul Wali; Efren Rosas; Molly P Clopp Journal: Perm J Date: 2012
Authors: G Pellino; D S Keller; G M Sampietro; V Annese; M Carvello; V Celentano; C Coco; F Colombo; N Cracco; F Di Candido; M Franceschi; S Laureti; G Mattioli; L Pio; G Sciaudone; G Sica; V Villanacci; R Zinicola; S Leone; S Danese; A Spinelli; G Delaini; F Selvaggi Journal: Tech Coloproctol Date: 2020-01-25 Impact factor: 3.781
Authors: G Pellino; D S Keller; G M Sampietro; I Angriman; M Carvello; V Celentano; F Colombo; F Di Candido; S Laureti; G Luglio; G Poggioli; M Rottoli; S Scaringi; G Sciaudone; G Sica; L Sofo; S Leone; S Danese; A Spinelli; G Delaini; F Selvaggi Journal: Tech Coloproctol Date: 2020-03-14 Impact factor: 3.781
Authors: Juliet June Ray; Eren Esen; Sarah McIntyre; Hasan T Kirat; Michael Grieco; Feza Remzi Journal: J Gastrointest Surg Date: 2020-11-12 Impact factor: 3.452
Authors: Michiel T J Bak; Marit F E Ruiterkamp; Oddeke van Ruler; Marjo J E Campmans-Kuijpers; Bart C Bongers; Nico L U van Meeteren; C Janneke van der Woude; Laurents P S Stassen; Annemarie C de Vries Journal: World J Gastroenterol Date: 2022-06-14 Impact factor: 5.374
Authors: Yizhen Guo; Lai Wei; Sandip H Patel; Gabrielle Lopez; Madison Grogan; Mingjia Li; Tyler Haddad; Andrew Johns; Latha P Ganesan; Yiping Yang; Daniel J Spakowicz; Peter G Shields; Kai He; Erin M Bertino; Gregory A Otterson; David P Carbone; Carolyn Presley; Samuel K Kulp; Thomas A Mace; Christopher C Coss; Mitch A Phelps; Dwight H Owen Journal: Clin Lung Cancer Date: 2022-01-08 Impact factor: 4.840
Authors: Ravi S Shah; Salam Bachour; Xue Jia; Stefan D Holubar; Tracy L Hull; Jean-Paul Achkar; Jessica Philpott; Taha Qazi; Florian Rieder; Benjamin L Cohen; Miguel D Regueiro; Amy L Lightner; Benjamin H Click Journal: J Crohns Colitis Date: 2021-07-05 Impact factor: 9.071