The reduced risk of septic shock/sepsis with laparoscopic surgery among ulcerative colitis patients with preoperative chronic steroid use

Lo, Brian D.; Stem, Miloslawa; Zhang, George Q.; Oduyale, Oluseye; Brocke, Tiffany; Efron, Jonathan E.; Atallah, Chady; Safar, Bashar

doi:10.1016/j.surg.2021.03.058

Cited by 3 publications

(6 citation statements)

References 22 publications

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“…They concluded that there was a decreased rate of post-operative sepsis/septic shock in both elective and emergent procedures in the laparoscopic group. Similar results were observed in patients on steroids who underwent laparoscopic surgery[ 41 ].…”

Section: Resultssupporting

confidence: 84%

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Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

Mowlah,

Soldera

2023

World J Gastrointest Surg

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BACKGROUND Indications for surgery in inflammatory bowel disease (IBD) include treatment-refractory disease or severe complications such as obstruction, severe colitis, dysplasia, or neoplasia. Infectious complications following colorectal surgery in IBD are significant, particularly in high-risk patients. AIM To gather evidence on risk factors associated with increased post-operative infectious complications in IBD and explore management strategies to reduce morbidity and mortality. METHODS A systematic review adhering to PRISMA-P guidelines was conducted. MEDLINE (PubMed) and Cochrane Library databases were searched using specific keywords. Inclusion criteria encompassed studies involving patients with IBD undergoing abdominal surgery with infectious complications within 30 d postoperatively. Exclusion criteria included patients under 18 years and non-infectious complications. Selected papers were analyzed to identify factors contributing to post-operative infections. A narrative analysis was performed to provide evidence-based recommendations for management. The data were then extracted and assessed based on the Reference Citation Analysis (https://www.referencecitationanalysis.com/ ). RESULTS The initial database search yielded 1800 articles, with 330 articles undergoing full-text review. After excluding duplicates and irrelevant papers, 35 articles were included for analysis. Risk factors for post-operative complications in patients with IBD included hypoalbuminemia, malnutrition, preoperative abscess, and obesity. Perioperative blood transfusion was associated with increased infectious complications. Medications such as 5-aminosalicylates and immunomodulators did not increase post-operative complications. Corticosteroids were associated with an increased risk of complications. Ustekinumab and vedolizumab showed similar rates of infectious complications compared to other treatments. The impact of minimally invasive surgery on post-operative complications varied across studies. CONCLUSION In order to reduce post-operative infectious complications in patients with IBD, a comprehensive approach involving multiple disciplines is necessary.

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Section: Resultssupporting

confidence: 84%

“…Lo et al [ 41 ] conducted a large retrospective cohort study involving 8644 patients with UC who underwent total abdominal colectomy without ileoanal anastomosis. They concluded that there was a decreased rate of post-operative sepsis/septic shock in both elective and emergent procedures in the laparoscopic group.…”

Section: Resultsmentioning

confidence: 99%

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

Mowlah,

Soldera

2023

World J Gastrointest Surg

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“…Lo et al published a retrospective analysis of ACS-NSQIP comparing outcomes between patients using preoperative steroids and those not using preoperative steroids who underwent surgery for UC and found that patients who underwent open surgery had higher rates of septic shock, regardless of steroid treatment. 15 The aforementioned increased rate of open procedures may be attributed to the presence of comorbidities such as type 2 diabetes, anemia, hypoalbuminemia, and the need for preoperative transfusions (which were found to be more common in this age group). Alternatively, it may be associated with older age itself, as the potentially longer operative time and requirement of pneumoperitoneum may lead surgeons to opt for an open approach.…”

Section: Discussionmentioning

confidence: 95%

Role of Age as a Predictor of Major Complications After Elective Surgery for Ulcerative Colitis

Areán-Sanz,

Ore,

Vigna

et al. 2023

The American Surgeon™

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Background The incidence of ulcerative colitis (UC) in the elderly population is increasing. The aim of this study was to assess the degree to which age and other factors increase the risk of developing major complications in patients undergoing elective surgery for UC. Methods Using the ACS-NSQIP database from 2016 to 2020, patients undergoing elective surgery for UC were divided into four categories: younger than 30, 30-49, 50-69, and 70 or older. A composite outcome was created including major complications and multivariable analysis was performed to identify factors associated with composite major complications. Results 5946 patients diagnosed with ulcerative colitis who underwent elective surgery were included in the analysis. 14.1% of all patients developed a major complication. For patients with UC, factors associated with the development of a major complication were age 50-69 (OR 1.31, P = .034), male sex (OR 1.38, P < .001), Black race (OR 1.47, P = .049), dependent status (OR 2.06, P = .028), hypoalbuminemia (OR 1.92, P < .001), preoperative steroid treatment (OR 1.27, P = .038), preoperative transfusion (OR 1.91, P < .001), open surgical approach (OR 1.44, P = .002), and partial colectomy (OR 1.51, P = .007). Specifically in patients aged 70 or older, hypoalbuminemia (OR 3.20, P < .001) and preoperative transfusion (OR 2.78, P = .019) were associated with a major complication. Conclusion Age is a risk factor for the development of a major complication in UC patients undergoing elective surgery. However, it is not the only risk factor nor is it the one that increases the risk the most.

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“…It may be interesting to see if laparoscopic surgery would improve the outcome of surgery in UC patients with chronic preoperative steroid use. Lo et al published a study in 2021 aiming to show that the use of laparoscopic surgery in UC patients with chronic preoperative steroid use would reduce the risk of septic shock/sepsis [ 52 ]. The study was conducted over 14 years (between 2005 and 2019) on a population sample of 8,644 patients with UC who underwent TPC identified from the National Surgical Quality Improvement Program (NSQIP) database from the American College of Surgeons [ 52 ].…”

Section: Reviewmentioning

confidence: 99%

“…Lo et al published a study in 2021 aiming to show that the use of laparoscopic surgery in UC patients with chronic preoperative steroid use would reduce the risk of septic shock/sepsis [ 52 ]. The study was conducted over 14 years (between 2005 and 2019) on a population sample of 8,644 patients with UC who underwent TPC identified from the National Surgical Quality Improvement Program (NSQIP) database from the American College of Surgeons [ 52 ]. Steroid use was present in 67.1% of patients, and nonsteroid use was present in 32.9%.…”

Section: Reviewmentioning

confidence: 99%

Surgical Treatment in Ulcerative Colitis, Still Topical: A Narrative Review

Slonovschi,

Kodela,

Okeke

et al. 2023

Cureus

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In this paper, different studies were integrated to conclude the impact of ulcerative colitis (UC) on the patient's vital prognosis, specifically highlighting the association with colorectal cancer (CRC). These severe complications have led us to consider studying the role of preventive surgery in managing UC. This study reviewed total preventive colectomy in UC patients for preventing the onset of CRC, the role of surgery in UC management, and its potential as a definitive treatment for the condition. The study also emphasized the effectiveness of annual colonoscopic monitoring and preventive colectomy in reducing the incidence of colorectal cancer (CRC). It discussed the role of laparoscopic surgery in minimizing postoperative complications and highlighted that partial surgical resection of the colon can be a viable option, offering improved bowel function without increasing the risk of CRC-related mortality. Elective surgery has an important place in UC management by preventing the development of forms requiring emergency surgery. Although surgery can cure UC, it can lead to significant postoperative complications and adverse effects.

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The reduced risk of septic shock/sepsis with laparoscopic surgery among ulcerative colitis patients with preoperative chronic steroid use

Cited by 3 publications

References 22 publications

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

Role of Age as a Predictor of Major Complications After Elective Surgery for Ulcerative Colitis

Surgical Treatment in Ulcerative Colitis, Still Topical: A Narrative Review

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