Digestive Diseases and Sciences

, Volume 58, Issue 10, pp 2955–2962 | Cite as

Surgical Outcomes in the Elderly with Inflammatory Bowel Disease are Similar to Those in the Younger Population

  • Marita C. Bautista
  • Mary F. Otterson
  • Yelena Zadvornova
  • Amar S. Naik
  • Daniel J. Stein
  • Nanda Venu
  • Lilani P. Perera
Original Article

Abstract

Background

Inflammatory bowel disease (IBD) has a bimodal distribution with approximately 15 % of patients manifesting after age 65. Previous reports suggest an increased risk of surgical complications in the elderly.

Aim

To compare surgical outcomes in elderly IBD patients (≥65 years at the time of surgery) to matched younger IBD cohorts.

Methods

This was a retrospective cohort study at a single academic center of patients who underwent surgery for IBD. Forty-two elderly patients (≥65 years) were matched at least 1:1 (median 1:5) to patients in each of three control groups [18–35 years (n = 71); 36–49 years (n = 62); 50–64 years (n = 58)] according to gender, disease type/location, and type of surgery. Postoperative complications were compared. Patient characteristics were used in multivariate risk models. Analysis was performed using ordinary logistic regression.

Results

Twenty ileal or ileocolonic resections, 12 partial or total colectomies, four stricturoplasties, and six laparoscopic partial or total colectomies were performed in the elderly group. The post-operative complication rate was not statistically different between the elderly and younger cohorts (38 % vs. 39 % vs. 40 % vs. 48 % in the 18–35, 36–49, 50–64, and ≥65 years groups, respectively, p = 0.26). The only significant risk factors for complication were Charlson comorbidity index (p = 0.0002), preoperative hemoglobin (p = 0.0065), total parenteral nutrition use (p = 0.024), and failed medical therapy (as the indication for surgery) (p = <0.0001).

Conclusions

The surgical complication rate among elderly and younger IBD patients was similar. Advanced age by itself should not be considered a risk factor for adverse operative outcome.

Keywords

Inflammatory bowel diseases Aged Outcomes assessment Surgical procedures Gastrointestinal 

Notes

Acknowledgments

We would like to thank Daniel Eastwood, MS for his work on our statistical analysis.

Conflict of interest

None.

Supplementary material

10620_2013_2754_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)

References

  1. 1.
    Robertson DJ, Grimm IS. Inflammatory bowel disease in the elderly. Gastroenterol Clin North Am. 2001;30:409–426.PubMedCrossRefGoogle Scholar
  2. 2.
    Pardi DS. Inflammatory bowel disease and aging. In: Scherl EJ, Dubinsky MC, eds. The changing world of inflammatory bowel disease. Throfare: SLACK Incorporated; 2009:193–200.Google Scholar
  3. 3.
    Chapman JR, Larson DW, Wolff BG, et al. Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome? Arch Surg. 2005;140:534–539.PubMedCrossRefGoogle Scholar
  4. 4.
    Norris B, Solomon MJ, Eyers AA, West RH, Glenn DC, Morgan BP. Abdominal surgery in the older Crohn’s population. Aust N Z J Surg. 1999;69:199–204.PubMedCrossRefGoogle Scholar
  5. 5.
    Page MJ, Poritz LS, Kunselman SJ, Koltun WA. Factors affecting surgical risk in elderly patients with inflammatory bowel disease. J Gastrointest Surg. 2002;6:606–613.PubMedCrossRefGoogle Scholar
  6. 6.
    Ananthakrishnan AN, McGinley EL, Binion DG. Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations. Inflamm Bowel Dis. 2009;15:182–189.PubMedCrossRefGoogle Scholar
  7. 7.
    Stein SL, Michelassi F. Surgical treatment of Crohn’s disease through the life cycle. In: Scherl EJ, Dubinsky MC, eds. The changing world of inflammatory bowel disease. Throfare: SLACK Incorporated; 2009:215–228.Google Scholar
  8. 8.
    Bauer JJ, Gorfine SR, Gelernt IM, Harris MT, Kreel I. Restorative proctocolectomy in patients older than fifty years. Dis Colon Rectum. 1997;40:562–565.PubMedCrossRefGoogle Scholar
  9. 9.
    Dayton MT, Larsen KR. Should older patients undergo ileal pouch-anal anastomosis? Am J Surg. 1996;172:444–7; discussion 447-8.Google Scholar
  10. 10.
    Delaney CP, Dadvand B, Remzi FH, Church JM, Fazio VW. Functional outcome, quality of life, and complications after ileal pouch-anal anastomosis in selected septuagenarians. Dis Colon Rectum. 2002;45:890–894; discussion 894.Google Scholar
  11. 11.
    Delaney CP, Fazio VW, Remzi FH, et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238:221–228.PubMedGoogle Scholar
  12. 12.
    Jorge JM, Wexner SD, James K, Nogueras JJ, Jagelman DG. Recovery of anal sphincter function after the ileoanal reservoir procedure in patients over the age of fifty. Dis Colon Rectum. 1994;37:1002–1005.PubMedCrossRefGoogle Scholar
  13. 13.
    Ho KS, Chang CC, Baig MK, et al. Ileal pouch anal anastomosis for ulcerative colitis is feasible for septuagenarians. Colorectal Dis. 2006;8:235–238.PubMedCrossRefGoogle Scholar
  14. 14.
    Lewis WG, Sagar PM, Holdsworth PJ, Axon AT, Johnston D. Restorative proctocolectomy with end to end pouch-anal anastomosis in patients over the age of fifty. Gut. 1993;34:948–952.PubMedCrossRefGoogle Scholar
  15. 15.
    Reissman P, Teoh TA, Weiss EG, Nogueras JJ, Wexner SD. Functional outcome of the double stapled ileoanal reservoir in patients more than 60 years of age. Am Surg. 1996;62:178–183.PubMedGoogle Scholar
  16. 16.
    Takao Y, Gilliland R, Nogueras JJ, Weiss EG, Wexner SD. Is age relevant to functional outcome after restorative proctocolectomy for ulcerative colitis?: prospective assessment of 122 cases. Ann Surg. 1998;227:187–194.PubMedCrossRefGoogle Scholar
  17. 17.
    Tan HT, Connolly AB, Morton D, Keighley MR. Results of restorative proctocolectomy in the elderly. Int J Colorectal Dis. 1997;12:319–322.PubMedCrossRefGoogle Scholar
  18. 18.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: Controversies, consensus, and implications. Gut. 2006;55:749–753.PubMedCrossRefGoogle Scholar
  19. 19.
    Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383.PubMedCrossRefGoogle Scholar
  20. 20.
    Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: A study of consistency of ratings. Anesthesiology. 1978;49:239–243.PubMedCrossRefGoogle Scholar
  21. 21.
    Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134:36–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Marita C. Bautista
    • 3
  • Mary F. Otterson
    • 2
  • Yelena Zadvornova
    • 1
  • Amar S. Naik
    • 1
  • Daniel J. Stein
    • 1
  • Nanda Venu
    • 1
  • Lilani P. Perera
    • 1
    • 4
  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Division of Colorectal Surgery, Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of MedicineKaiser Permanente Medical CenterSanta ClaraUSA
  4. 4.Clement J. Zablocki VA Medical CenterMilwaukeeUSA

Personalised recommendations