BACKGROUND: The surgical treatment of the elderly IBD patient has often been avoided in favor of medical management due to a perceived increased risk. This study sought to define in the elderly IBD patient: 1) the risk of surgical management, and 2) those factors affecting risk.
METHODS: 30 IBD patients 60 years old surgically managed by a single surgeon over a ten year period were retrospectively matched to 75 IBD patients < 60 years old according to gender, date of surgery and type of surgery performed (IPAA, ileocolectomy, proctocolectomy, small bowel resection, total abdominal colectomy). Secondary matching variable included diagnosis (Crohn's disease, ulcerative colitis) and case type (urgert vs elective). Studied endpoints included: operative time (OR), postoperative complications and length of stay (LOS). Univariant and multivariant statistical analysis using Generalized Estimating Equations (GEE) was performed to evaluate the effect of comorbidities, surgical indication and immunosuppressive medications (steroids, imuran) on these endpoints.
RESULTS: Using univariant analysis, elderly IBD patients had a 3.5 greater risk of complication (47% vs 20% p£.01) with longer LOS (11.5 days vs 7 days p£.05) and OR time (249 min vs 212 min p£.05) compared to younger IBD patients. Multivariant analysis of these differences showed that the increased complication rate and LOS were not due to the presence of comorbidities or immunosuppressive therapy. The increased complication rate did relate to the surgical indication, with obstruction, fistula and bleeding having a progressively increasing relative risk (odds ratio 1.7 vs 4.2 vs 7.2 p£.05) No factors studied explained the increased OR time whereas the increased LOS was associated with operations for fistulous disease (10.5 days vs 9.8 for bleeding vs 7.4 for obstruction p£.05).
CONCLUSIONS: Elderly IBD patients have an increase risk of postoperative complications, LOS and OR time. This is unrelated to comorbidities or immunosuppressive therapy. Complications are most dependant on surgical indication, with obstruction being the least and bleeding the worst predictive factors. The greatest LOS is associated with surgery for fistulous disease. The fact that the higher complication rate seen in the older IBD patient is directly related to disease defined surgical indication, suggests that IBD in the elderly patient is of a more aggressive variety than that seen in younger individuals.
