1
|
Zhang X, Dong X, Luo H, Song Y, Chen S. The Impact of Improved Compliance With Enhanced Recovery After Surgery on Frail Patients Undergoing Multi-Level Posterior Lumbar Fusion Surgery for Degenerative Lumbar Diseases. Geriatr Orthop Surg Rehabil 2024; 15:21514593241273117. [PMID: 39156480 PMCID: PMC11329897 DOI: 10.1177/21514593241273117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024] Open
Abstract
Background Patients with frailty are more prone to have perioperative adverse events, and enhanced recovery after surgery (ERAS) has been widely adopted to improve perioperative outcomes. The purpose of this study was to assess the impact of improved compliance with ERAS on perioperative outcomes in frail patients. Methods Geriatric patients (over 65 years) who underwent multi-level lumbar fusion surgery between June 2017 and June 2022 were included. The patients were divided into two groups according to their degree of compliance with the ERAS. Stepwise nearest-neighbor propensity score matching 1:1 cohorts for age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classfication and Charlson Comorbidity Index (CCI) was performed between groups, namely frail-compliant (FC), frail-noncompliant (FN). Further length of stay (LOS), complications and clinical efficacy were compared between groups. Results There were 83 pairs of well-balanced patients with comparable clinical baseline data. It was worth noting that patients in FC group has significant lower overall complications (20.5% in the FC group vs 39.8% in the FN group, P = 0.007), major complications (7.2% in the FC group vs 19.3% in the FN group, P = 0.022) and shorter LOS (11.18 ± 5.32 in the FC group vs 14.45 ± 4.68 in the FN group, P < 0.001) than patients in FN group. In addition, the initial occurrence of ambulation (2.14 ± 1.21 in FC group vs 3.18 ± 1.73 in FN group, P = 0.012) and bowel movement (3.68 ± 1.24 in FC group vs 4.17 ± 1.32 in FN group, P = 0.031) were earlier for patients in FC group than patients in FN group. With regard to clinical efficacy, there were no significant difference between FC and FN group in terms of patients who meet minimal clinical important difference (MCID) for Oswestry Disability Index (ODI) at postoperative day (POD) 30, Visual Analog Scale (VAS) for back at POD 30-90 and VAS for legs at POD 30, 90, and 180 follow-up intervals. However, there were significant more patients meeting MCID for ODI at POD 90 and180, and VAS for back at POD 180 between FC and FN group. Conclusions In this retrospective cohort study, we found that frail patients with higher ERAS adherence group had a lower incidence of overall complication, mjor complications, and a shorter LOS than their lower ERAS adherence counterparts. In addition, frail patients with higher ERAS adherence had earlier ambulatioin and bowel movement. More importantly, we found there were significant more patients meeting MCID for ODI at POD 90 and180, and VAS for back at POD 180 in higher ERAS adherence than their lower counterparts.
Collapse
Affiliation(s)
- Xiaoying Zhang
- Department of Pediatrics, Qianxi County People’s Hospital, Shijiazhuang, Hebei China
| | - Xuewei Dong
- Department of Spinal surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huili Luo
- Department of Spinal surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanli Song
- Department of Spinal surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shengmin Chen
- Department of Spinal surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
2
|
Aras OA, Patel AS, Satchell EK, Serniak NJ, Byrne RM, Cagir B. Comparison of outcomes in small bowel surgery for Crohn's disease: a retrospective NSQIP review. Int J Colorectal Dis 2024; 39:119. [PMID: 39073495 PMCID: PMC11286688 DOI: 10.1007/s00384-024-04661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Despite advances in medical therapy, approximately 33% of Crohn's disease (CD) patients will need surgery within 5 years after initial diagnosis. Several surgical approaches to CD have been proposed including small bowel resection, strictureplasty, and combined surgery with resection plus strictureplasty. Here, we utilize the American College of Surgeons (ACS) national surgical quality registry (NSQIP) to perform a comprehensive analysis of 30-day outcomes between these three surgical approaches for CD. METHODS The authors queried the ACS-NSQIP database between 2015 and 2020 for all patients undergoing open or laparoscopic resection of small bowel or strictureplasty for CD using CPT and IC-CM 10. Outcomes of interest included length of stay, discharge disposition, wound complications, 30-day related readmission, and reoperation. RESULTS A total of 2578 patients were identified; 87% of patients underwent small bowel resection, 5% resection with strictureplasty, and 8% strictureplasty alone. Resection plus strictureplasty (combined surgery) was associated with the longest operative time (p = 0.002). Patients undergoing small bowel resection had the longest length of hospital stay (p = 0.030) and the highest incidence of superficial/deep wound infection (44%, p = 0.003) as well as the highest incidence of sepsis (3.5%, p = 0.03). Small bowel resection was found to be associated with higher odds of wound complication compared to combined surgery (OR 2.09, p = 0.024) and strictureplasty (1.9, p = 0.005). CONCLUSION Our study shows that various surgical approaches for CD are associated with comparable outcomes in 30-day related reoperation and readmission, or disposition following surgery between all three surgical approaches. However, small bowel resection displayed higher odds of developing post-operative wound complications.
Collapse
Affiliation(s)
- Oguz Az Aras
- Department of Surgery, Guthrie Clinic, Guthrie Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840, USA.
- Department of Internal Medicine, TriStar Centennial Medical Center, Nashville, TN, USA.
| | - Apar S Patel
- Department of Surgery, Guthrie Clinic, Guthrie Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840, USA
- Department of Surgery, Geisinger Health System, Danville, PA, USA
| | - Emma K Satchell
- Department of Surgery, Guthrie Clinic, Guthrie Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840, USA
| | - Nicholas J Serniak
- Department of Surgery, Guthrie Clinic, Guthrie Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840, USA
| | - Raphael M Byrne
- Department of Surgery, Guthrie Clinic, Guthrie Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840, USA
| | - Burt Cagir
- Department of Surgery, Guthrie Clinic, Guthrie Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840, USA
| |
Collapse
|
3
|
Micheal J, Sothinglingham N, Schwartz NJ, Guver A, D'Adamo CR, Lipkin S, Demos J, Felton J, Wolf JH. Comparison of Post-hemorrhoid Surgery Pain Profiles in Older and Younger Adults. J Surg Res 2024; 301:572-577. [PMID: 39059125 DOI: 10.1016/j.jss.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/31/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Older and younger adults are offered similar analgesic options after hemorrhoid surgery (HS), but the differences in pain between the two populations are unknown. This study aims to compare postoperative pain outcomes after HS in older and younger individuals. METHODS This is a retrospective analysis of electronic medical records of patients who underwent HS between 2018 and 2023. Patients were excluded if additional anorectal procedures were performed at the time of HS. Data related to pain-related outcomes were compiled: (1) need for narcotic prescription refills; (2) documentation of a pain-related phone call within 30 d; (3) urgent postoperative office visit before regular scheduled follow-up; and (4) pain-related postoperative emergency department visits. Associations between age and pain-related outcomes were tested using Fisher's exact test, chi-square test, and covariate adjusted logistic regression modeling. RESULTS There were a total of 249 patients, 60 older adults, and 189 younger adults. Compared to younger patients, older adults demonstrated a reduced frequency of pain-related phone calls (10.3 versus 32.1%, P < 0.01) and opioid refills (0 versus 14.4%, P < 0.01). After adjusting for confounders, older age remained inversely associated with pain-related postoperative phone calls (odds ratio = 0.25, 95% confidence interval = [0.1-0.6], P = 0.003). CONCLUSIONS Older adults had better pain outcomes after HS in comparison to younger patients. These findings suggest that the postoperative analgesic needs of older patients after HS are lower than those of younger patients. Decisions regarding opioid prescription in older adults recovering from HS should be tailored to avoid narcotic-related complications.
Collapse
Affiliation(s)
- Joseph Micheal
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland; Xavier University School of Medicine, Oranjestad, Aruba
| | - Nishan Sothinglingham
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland; Saba University School of Medicine, Saba, Netherlands Antilles
| | - Nathaniel J Schwartz
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland; Touro College of Osteopathic Medicine, Harlem, New York
| | - Alperen Guver
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Christopher R D'Adamo
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland; Department of Epidemiology and Public Health, Department of Family and Community Medicine, University of Maryland, Baltimore, Maryland
| | - Sloane Lipkin
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jasmine Demos
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jessica Felton
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Joshua H Wolf
- Department of Colorectal Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| |
Collapse
|
4
|
Neelam PB, Sharma A, Sharma V. Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence. JGH Open 2024; 8:e13033. [PMID: 38283070 PMCID: PMC10821747 DOI: 10.1002/jgh3.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/01/2024] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Sarcopenia is a condition marked by progressive loss of skeletal muscle mass and function while frailty is a multidimensional concept characterized by diminished physiological reserve and increased vulnerability to stressors. Both of these were previously considered as related to aging and shown to impact the quality of life and carry prognostic significance. Emerging data show that both sarcopenia and frailty carry similar relevance in chronic illness. Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and malnourishment, both of which contribute to the development of sarcopenia by increasing protein breakdown and reducing protein synthesis. The coexistence of frailty further compounds the clinical complexity of IBD patients. Published evidence suggests a bidirectional association with IBD contributing to muscle wasting, while the resultant sarcopenia and frailty could further exacerbate the disease course. Sarcopenia and frailty are independently associated with adverse outcomes, including hospitalizations, increased surgical interventions, and surgical complications. As therapeutic strategies for IBD evolve, understanding the nuanced relationship between inflammatory bowel disease, sarcopenia, and frailty is crucial for devising holistic management. Comprehensive care should encompass not only disease-modifying therapies but also interventions targeting frailty and sarcopenia, as they have been shown to have a significant impact not only on the disease course but also on the quality of life. Future research could focus on further elucidating underlying mechanisms, simple screening strategies, and developing targeted interventions to improve the overall quality of life for individuals grappling with the complex interplay of IBD, sarcopenia, and frailty.
Collapse
Affiliation(s)
- Pardhu B Neelam
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Alka Sharma
- Department of MedicineDr. BR Ambedkar Institute of Medical SciencesMohaliIndia
| | - Vishal Sharma
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| |
Collapse
|
5
|
Fernandez C, Gajic Z, Esen E, Remzi F, Hudesman D, Adhikari S, McAdams-DeMarco M, Segev DL, Chodosh J, Dodson J, Shaukat A, Faye AS. Preoperative Risk Factors for Adverse Events in Adults Undergoing Bowel Resection for Inflammatory Bowel Disease: 15-Year Assessment of the American College of Surgeons National Surgical Quality Improvement Program. Am J Gastroenterol 2023; 118:2230-2241. [PMID: 37410929 PMCID: PMC10841104 DOI: 10.14309/ajg.0000000000002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Older adults with inflammatory bowel disease (IBD) are at higher risk for postoperative complications as compared to their younger counterparts; however, factors contributing to this are unknown. We assessed risk factors associated with adverse IBD-related surgical outcomes, evaluated trends in emergency surgery, and explored differential risks by age. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified adults ≥18 years of age who underwent an IBD-related intestinal resection from 2005 to 2019. Our primary outcome included a 30-day composite of mortality, readmission, reoperation, and/or major postoperative complication. RESULTS Overall, 49,746 intestinal resections were performed with 9,390 (18.8%) occurring among older adults with IBD. Nearly 37% of older adults experienced an adverse outcome as compared to 28.1% among younger adults with IBD ( P < 0.01). Among all adults with IBD, the presence of preoperative sepsis (adjusted odds ratio [aOR], 2.08; 95% confidence interval [CI] 1.94-2.24), malnutrition (aOR, 1.22; 95% CI 1.14-1.31), dependent functional status (aOR, 6.92; 95% CI 4.36-11.57), and requiring emergency surgery (aOR, 1.50; 95% CI 1.38-1.64) increased the odds of an adverse postoperative outcome, with similar results observed when stratifying by age. Furthermore, 8.8% of surgeries among older adults were emergent, with no change observed over time ( P = 0.16). DISCUSSION Preoperative factors contributing to the risk of an adverse surgical outcome are similar between younger and older individuals with IBD, and include elements such as malnutrition and functional status. Incorporating these measures into surgical decision-making can reduce surgical delays in older individuals at low risk and help target interventions in those at high risk, transforming care for thousands of older adults with IBD.
Collapse
Affiliation(s)
- Cristina Fernandez
- Department of Medicine at New York University Langone Health, New York, NY, USA
| | - Zoran Gajic
- Department of Medicine at New York University Langone Health, New York, NY, USA
| | - Eren Esen
- Department of Surgery at New York University Langone Health, New York, NY, USA
| | - Feza Remzi
- Department of Surgery at New York University Langone Health, New York, NY, USA
| | - David Hudesman
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Samrachana Adhikari
- Department of Population Health at New York University Langone Health, New York, NY, USA
| | | | - Dorry L. Segev
- Department of Surgery at New York University Langone Health, New York, NY, USA
| | - Joshua Chodosh
- Department of Medicine at New York University Langone Health, Division of Geriatric Medicine and Palliative Care, New York, NY, USA
| | - John Dodson
- Department of Medicine at New York University Langone Health, Division of Cardiology, New York, NY, USA
| | - Aasma Shaukat
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Adam S. Faye
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| |
Collapse
|
6
|
Metoyer GT, Ali Asgar J, D'Adamo CR, Wolf JH, Katlic M, Svoboda S, Mavanur A. The modified frailty index predicts postoperative venous thromboembolism incidence better than older age in colorectal surgery patients. Am J Surg 2023:S0002-9610(23)00440-3. [PMID: 37802702 DOI: 10.1016/j.amjsurg.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Garyn T Metoyer
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA.
| | - Juzer Ali Asgar
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; University of Medicine and Health Sciences, 275 7th Ave 26th Floor, New York, NY, 10001, USA.
| | - Christopher R D'Adamo
- Department of Family and Community Medicine, University of Maryland School of Medicine, Center for Integrative Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
| | - Joshua H Wolf
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; Department of Surgery, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
| | - Mark Katlic
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; Department of Surgery, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
| | - Shane Svoboda
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA.
| | - Arun Mavanur
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
| |
Collapse
|
7
|
Rozich JJ, Zhao B, Luo J, Luo WY, Eisenstein S, Singh S. Conventional Frailty Index Does Not Predict Risk of Postoperative Complications in Patients With IBD: A Multicenter Cohort Study. Dis Colon Rectum 2023; 66:1085-1094. [PMID: 36622750 DOI: 10.1097/dcr.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Frailty has been associated with adverse outcomes in patients with IBD. OBJECTIVE This study aimed to evaluate the association between health deficit-defined frailty (using the 5-factor modified frailty index) and postoperative outcomes in patients with IBD. DESIGN Prospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program, Inflammatory Bowel Diseases Module. PATIENTS The included patients had IBD and underwent major abdominal surgery between 2016 and 2019. Patients were classified as frail (modified frailty index ≥2), prefrail (modified frailty index = 1), or normal (modified frailty index = 0) based on a validated, 5-factor modified frailty index. MAIN OUTCOME MEASURES The association was evaluated between frailty and risk of 30-day severe postoperative complications, prolonged hospital stay, and risk of readmission using multivariable logistic regression. RESULTS Of 3172 patients with IBD who underwent major abdominal surgery (42.7 ± 16.4 y, 49.3% female, 57.7% with Crohn's disease, 43.9% on biologics), 116 (3.7%) were classified as frail and 477 as prefrail (15%). After adjustment for age, sex, race/ethnicity, smoking, BMI, type of surgery, corticosteroid use, and biologic and immunomodulator use, frailty was not associated with increased risk for severe postoperative complications (adjusted OR, 1.24; 95% CI, 0.81-1.90), mortality (adjusted OR, 1.38 [0.44-3.6]), or 30-day readmission (adjusted OR, 1.35 [0.77-2.30]). Nonelective surgery, significant weight loss, corticosteroid use, and need for ileostomy were associated with increased risk of severe postoperative complications. LIMITATIONS Limited information regarding IBD-specific characteristics. CONCLUSIONS In patients with IBD undergoing major abdominal surgery, frailty measured by a conventional abbreviated health deficits index is not predictive of adverse postoperative outcomes. Biologic and functional measures of frailty may better risk-stratify surgical candidacy in patients with IBDs. See Video Abstract at http://links.lww.com/DCR/C108 . EL NDICE DE FRAGILIDAD CONVENCIONAL NO PREDICE EL RIESGO DE COMPLICACIONES POSOPERATORIAS EN PACIENTES CON ENFERMEDADES INFLAMATORIAS DEL INTESTINO UN ESTUDIO DE COHORTE MULTICNTRICO ANTECEDENTES:La fragilidad se ha asociado con resultados adversos en pacientes con enfermedades inflamatorias del intestino.OBJETIVO:Examinamos la asociación entre la fragilidad definida por déficit de salud (utilizando el índice de fragilidad modificado de 5 factores) y los resultados postoperatorios en pacientes con enfermedades inflamatorias del intestino.DISEÑO:Estudio de cohorte prospective.ESCENARIO:Programa Nacional de Mejoramiento de la Calidad Quirúrgica del Colegio Estadounidense de Cirujanos, Módulo de Enfermedades Inflamatorias del Intestino.PACIENTES:Pacientes con enfermedades inflamatorias intestinales inscritos en la cohorte que se sometieron a cirugía abdominal mayor entre 2016-19.EXPOSICIÓN:Los pacientes se clasificaron como frágiles (índice de fragilidad modificado ≥2), prefrágiles (índice de fragilidad modificado = 1) o normales (índice de fragilidad modificado = 0) según un índice de fragilidad modificado de 5 factores validado.PRINCIPALES MEDIDAS DE RESULTADO:Examinamos la asociación entre la fragilidad y el riesgo de complicaciones postoperatorias graves a los 30 días, la estancia hospitalaria prolongada y el riesgo de reingreso, mediante regresión logística multivariable.RESULTADOS:De 3172 pacientes con enfermedades inflamatorias intestinales que se sometieron a cirugía abdominal mayor (42,7 ± 16,4 años, 49,3% mujeres, 57,7% con enfermedad de Crohn, 43,9% con biológicos), 116 (3,7%) fueron clasificados como frágiles y 477 como pre- frágil (15%). Después de ajustar por edad, sexo, raza/origen étnico, tabaquismo, índice de masa corporal, tipo de cirugía, uso de corticosteroides, uso de biológicos e inmunomoduladores, la fragilidad no se asoció con un mayor riesgo de complicaciones postoperatorias graves (odds ratio ajustado, 1,24; 95 % de confianza intervalos, 0,81-1,90), mortalidad (odds ratio ajustado, 1,38 [0,44-3,6]) o reingreso a los 30 días (odds ratio ajustado, 1,35 [0,77-2,30]). La cirugía no electiva, la pérdida de peso significativa, el uso de corticosteroides y la necesidad de ileostomía se asociaron con un mayor riesgo de complicaciones posoperatorias graves.LIMITACIONES:Información limitada sobre las características específicas de la enfermedad inflamatoria intestinal.CONCLUSIONES:En pacientes con enfermedades inflamatorias del intestino sometidos a cirugía abdominal mayor, la fragilidad medida por un índice de déficit de salud abreviado convencional no es predictivo de resultados postoperatorios adversos. Las medidas biológicas y funcionales de fragilidad pueden estratificar mejor la candidatura quirúrgica en pacientes con enfermedades inflamatorias del intestino. Consulte el Video Resumen en http://links.lww.com/DCR/C108 . (Traducción-Yesenia Rojas-Khalil ).
Collapse
Affiliation(s)
- Jacob J Rozich
- Department of Internal Medicine, University of California, San Diego, La Jolla, California
| | - Beiqun Zhao
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, La Jolla, California
| | - Jiyu Luo
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - William Y Luo
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Samuel Eisenstein
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, San Diego, La Jolla, California
| | - Siddharth Singh
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, California
| |
Collapse
|
8
|
Azimaraghi O, Bilal M, Amornyotin S, Arain M, Behrends M, Berzin TM, Buxbaum JL, Choice C, Fassbender P, Sawhney MS, Sundar E, Wongtangman K, Leslie K, Eikermann M. Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography. Br J Anaesth 2023; 130:763-772. [PMID: 37062671 DOI: 10.1016/j.bja.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Deep sedation without tracheal intubation (monitored anaesthesia care) and general anaesthesia with tracheal intubation are commonly used anaesthesia techniques for endoscopic retrograde cholangiopancreatography (ERCP). There are distinct pathophysiological differences between monitored anaesthesia care and general anaesthesia that need to be considered depending on the nature and severity of the patient's underlying disease, comorbidities, and procedural risks. An international group of expert anaesthesiologists and gastroenterologists created clinically relevant questions regarding the merits and risks of monitored anaesthesia care vs general anaesthesia in specific clinical scenarios for planning optimal anaesthetic approaches for ERCP. Using a modified Delphi approach, the group created practical recommendations for anaesthesiologists, with the aim of reducing the incidence of perioperative adverse outcomes while maximising healthcare resource utilisation. In the majority of clinical scenarios analysed, our expert recommendations favour monitored anaesthesia care over general anaesthesia. Patients with increased risk of pulmonary aspiration and those undergoing prolonged procedures of high complexity were thought to benefit from general anaesthesia with tracheal intubation. Patient age and ASA physical status were not considered to be factors for choosing between monitored anaesthesia care and general anaesthesia. Monitored anaesthesia care is the favoured anaesthesia plan for ERCP. An individual risk-benefit analysis that takes into account provider and institutional experience, patient comorbidities, and procedural risks is also needed.
Collapse
Affiliation(s)
- Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Somchai Amornyotin
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mustafa Arain
- Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA
| | - Matthias Behrends
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James L Buxbaum
- Department of Internal Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Curtis Choice
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Philipp Fassbender
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eswar Sundar
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kate Leslie
- Monash University, Melbourne, VIC, Australia; Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
| |
Collapse
|
9
|
Salvatori S, Marafini I, Franchin M, Lavigna D, Brigida M, Venuto C, Biancone L, Calabrese E, Giannarelli D, Monteleone G. Reversibility of Frail Phenotype in Patients with Inflammatory Bowel Diseases. J Clin Med 2023; 12:jcm12072658. [PMID: 37048741 PMCID: PMC10095533 DOI: 10.3390/jcm12072658] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
It was recently reported that frailty status can negatively influence the clinical course of patients with inflammatory bowel diseases (IBDs). Our recent study demonstrated that 20% of patients with an IBD are frail, and disease activity increases the risk of frailty. In the present study, we prospectively monitored this subgroup of frail patients, assessed whether the frailty status was reversible, and analyzed factors associated with frailty reversibility. Of the sixty-four frail patients with IBD enrolled, five (8%) were lost during the follow-up period and one (2%) underwent a colectomy. Eleven out of the fifty-eight (19%) patients maintained a frail phenotype during a median follow-up of 8 months (range 6–19 months), and thirty-five (60%) and twelve (21%) became pre-frail or fit, respectively. A comparison of the 58 patients at baseline and at the end of the study showed that frail phenotype reversibility occurred more frequently in patients who achieved clinical remission. A multivariate analysis showed that the improvement of the frail phenotype was inversely correlated with the persistence of clinically active disease (OR:0.1; 95% CI: 0.02–0.8) and a history of extra-intestinal manifestations (OR:0.1; 95% CI: 0.01–0.6) and positively correlated with the use of biologics (OR: 21.7; 95% CI: 3.4–263). Data indicate that the frail phenotype is a reversible condition in most IBD patients, and such a change relies on the improvement in disease activity.
Collapse
Affiliation(s)
- Silvia Salvatori
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
| | - Irene Marafini
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
| | - Martina Franchin
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
| | - Diletta Lavigna
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
| | - Mattia Brigida
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
| | - Chiara Venuto
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
| | - Livia Biancone
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Monteleone
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
| |
Collapse
|
10
|
Fons A, Kalisvaart K, Maljaars J. Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence. J Clin Med 2023; 12:jcm12020533. [PMID: 36675461 PMCID: PMC9860672 DOI: 10.3390/jcm12020533] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty assessment methods, the prevalence of frailty, risk factors for frailty and the prognostic value of frailty in IBD. A scoping literature search was performed using the PubMed database. Frailty prevalence varied from 6% to 53.9%, depending on the population and frailty assessment method. Frailty was associated with a range of adverse outcomes, including an increased risk for all-cause hospitalization and readmission, mortality in non-surgical setting, IBD-related hospitalization and readmission. Therefore, frailty assessment should become integrated as part of routine clinical care for older patients with IBD.
Collapse
Affiliation(s)
- Anne Fons
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
- Correspondence: ; Tel.: +31-71-526-3507
| | - Kees Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
| | - Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
11
|
Huang X, Xiao M, Jiang B, Wang X, Tang X, Xu X, Chen Y, Wang S, Yan S, Wang S, Wang J, Zhang P. Prevalence of frailty among patients with inflammatory bowel disease and its association with clinical outcomes: a systematic review and meta-analysis. BMC Gastroenterol 2022; 22:534. [PMID: 36550400 PMCID: PMC9773593 DOI: 10.1186/s12876-022-02620-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies have reported frailty as an independent risk factor of mortality in patients with inflammatory bowel disease (IBD). However, no systematic review and meta-analysis has been conducted to determine the relationship of frailty and IBD. We aimed to investigate the prevalence of frailty in patients with IBD and the impact of frailty on the clinical prognosis of these patients. METHODS We systematically searched PubMed, Ovid (Medline), Embase, Web of Science, and Cochrane Library from database inception until October 2022. This systematic review included observational studies describing IBD and frailty. We performed meta-analysis for the frailty prevalence in patients with IBD. We analyzed primary outcomes (mortality) and secondary outcomes (infections, hospitalizations, readmission, and IBD-related surgery). RESULTS Nine studies with a total of 1,495,695 participants were included in our meta-analysis. The prevalence of frailty was 18% in patients with IBD. The combined effect analysis showed that frail patients with IBD had a higher risk of mortality (adjusted hazard ratio = 2.25, 95% confidence interval: 1.11-4.55) than non-frail patients with IBD. The hazard ratio for infections (HR = 1.23, 0.94-1.60), hospitalizations (HR = 1.72, 0.88-3.36), readmission (HR = 1.21, 1.17-1.25) and IBD-related surgery (HR = 0.78, 0.66-0.91) in frail patients with IBD. CONCLUSIONS We demonstrated that frailty is a significant independent predictor of mortality in patients with IBD. Our work supports the importance of implementing frailty screening upon admission in patients with IBD. More prospective studies are needed to investigate the influence of frailty on patients with IBD and improve the poor prognosis of patients with frailty and IBD.
Collapse
Affiliation(s)
- Xiangting Huang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Mengmeng Xiao
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Benyue Jiang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Xiuzheng Wang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Xiaoyu Tang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Xiao Xu
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Ying Chen
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Shixuan Wang
- grid.9613.d0000 0001 1939 2794Department of Philosophy, University of Jena, Jena, Germany
| | - Songbo Yan
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Siyi Wang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Jiang Wang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| | - Pinglan Zhang
- grid.440809.10000 0001 0317 5955Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province China
| |
Collapse
|
12
|
Cui P, Wang P, Hu X, Kong C, Lu S. Comparison of Perioperative Outcomes in Patients Undergoing Short-Level Lumbar Fusion Surgery After Implementing Enhanced Recovery After Surgery: A Propensity Score Matching Analysis Focusing on Young-Old and Old-Old. Clin Interv Aging 2022; 17:1793-1801. [PMID: 36506849 PMCID: PMC9733441 DOI: 10.2147/cia.s389927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Background There were exponentially increased studies focused on revealing the satisfactory outcomes after implementing enhanced recovery after surgery (ERAS) in patients undergoing lumbar fusion surgery. However, little attention has been paid to the impact of chronologic age alone on perioperative outcomes. Methods In the present study, patients were dichotomized into two groups: young-old (65-79 years), and old-old (80 years and older). Given the heterogeneity and age-related comorbidities in this population and the need to compare similar groups, we performed propensity score matching for gender, body mass index (BMI), operation time, American Society of Anesthesiologists (ASA) grade, Charlson Comorbidity Index (CCI), fusion levels and frail status. Perioperative outcomes were compared between two groups. Results In our study, we found there were significant discrepancies in length of stay (LOS) (7.17 ± 2.81 vs 8.11 ± 3.57 days, p = 0.031) and postoperative nausea and vomiting (3.7% vs 11.0%, p = 0.038); however, there were no significant differences in C-reactive protein (21.50 ± 26.52 vs 19.22 ± 22.04 mg/L, p = 0.490), overall complication rates (24.8% vs 33.0%, p = 0.179), ambulation time (2.89 ± 1.34 vs 2.55 ± 1.49 days, p = 0.078) or removal of urinary catheter time (2.47 ± 1.44 vs 2.32 ± 1.40 days, p = 0.446). Conclusion There were few differences in perioperative outcomes between young-old and old-old groups. Despite similar postoperative complication rates, the old-old group might experience longer LOS when complications occur. More importantly, current outcomes suggested that chronologic age alone does not appear to have the capacity to reflect the tolerance of elderly patients to surgery.
Collapse
Affiliation(s)
- Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China,Correspondence: Chao Kong; Shibao Lu, Email ;
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| |
Collapse
|
13
|
Amini N, D'Adamo CR, Khashchuk D, Dodson R, Katlic M, Wolf J, Mavanur A. Accuracy of National Surgical Quality Improvement Program Risk Calculator Among Elderly Patients Undergoing Pancreas Resection. J Surg Res 2022; 279:567-574. [DOI: 10.1016/j.jss.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/12/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022]
|
14
|
Cui P, Wang P, Wang J, Liu X, Kong C, Lu S. The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis. Clin Interv Aging 2022; 17:1297-1306. [PMID: 36046544 PMCID: PMC9422991 DOI: 10.2147/cia.s378327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age. Methods We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications. Results A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients. Conclusion After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.
Collapse
Affiliation(s)
- Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Jialin Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Xu Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
- Correspondence: Chao Kong; Shibao Lu, Email ;
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| |
Collapse
|
15
|
Vieujean S, Caron B, Jairath V, Benetos A, Danese S, Louis E, Peyrin-Biroulet L. Is it time to include older adults in inflammatory bowel disease trials? A call for action. THE LANCET. HEALTHY LONGEVITY 2022; 3:e356-e366. [PMID: 36098310 DOI: 10.1016/s2666-7568(22)00060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
The therapeutic management of older patients with inflammatory bowel disease (IBD) is challenging, particularly because of the absence of evidence-based guidelines for these patients, who seem to frequently be excluded from clinical trials. In this systematic review we investigated the exclusion of older patients with IBD from phase 3 studies registered on PubMed and ClinicalTrials.gov, by assessing the upper limit of age exclusion criteria and the percentage of patients older than 65 years included in the trials. Exclusion criteria other than age were also recorded, and comorbidities were analysed separately. Our review of 222 phase 3 studies shows that older patients are frequently excluded from IBD clinical trials because of their age, which was used as an exclusion criterion in 129 (58%) of the 222 assessed trials. Of the 32 trials that detailed the percentage of included patients who were 65 years or older, only 763 (5·4%) patients of the 14 124 patients included were older than 65 years. In addition to age, patients were also excluded because of comorbidities (mainly renal, hepatic, and cardiovascular, and used as an exclusion criterion in 76% of trials), a history of dysplasia (45% of trials), and previous treatment for IBD (19% of trials). We propose a three-step process that should enable the inclusion of all older patients in IBD clinical trials, regardless of their age, comorbidities, and frailty.
Collapse
Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Vipul Jairath
- Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Alimentiv, London, ON, Canada
| | - Athanase Benetos
- Inserm, DCAC, University of Lorraine, Vandoeuvre-lès-Nancy, France; CHRU-Nancy Brabois, Department of Clinical Geriatrics, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France.
| |
Collapse
|