Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn’s Disease Patients

Hirsch, Ayal; Yarur, Andrés; Dezheng, Hou; Rodriquez, Dylan M.; Cleveland, Noa Krugliak; Ali, Tauseef; Hurst, Roger D.; Umanskiy, Konstantin; Hyman, Neil; Colwell, Janice C.; Rubin, David T.

doi:10.1007/s11605-015-2908-y

Cited by 15 publications

(15 citation statements)

References 31 publications

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“…There were many known risk factors that could further increase the odds. In general, patients with penetrating disease or with unfavorable biochemistry parameters such as hypoalbuminemia and anemia were often at risk of developing infections after surgery [ 4 , 28–30 ]. Furthermore, pre-operative medications such as corticosteroids, biologics and even narcotic use were cited to increase the incidence of infectious complications [ 4 , 5 , 28 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In general, patients with penetrating disease or with unfavorable biochemistry parameters such as hypoalbuminemia and anemia were often at risk of developing infections after surgery [ 4 , 28–30 ]. Furthermore, pre-operative medications such as corticosteroids, biologics and even narcotic use were cited to increase the incidence of infectious complications [ 4 , 5 , 28 , 30 ]. Complex surgery and a longer duration of surgery were all relevant factors that might lead to infection [ 2 , 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

Stocchi

et al. 2017

Gastroenterology Report

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BackgroundWe have previously demonstrated that blood transfusion (BT) was associated with post-operative complications in patients undergoing surgery for Crohn’s disease (CD), based on our institutional data registry. The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.MethodsAll CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP. Variables were defined according to the ACS NSQIP guidelines. The primary outcome was infectious complications, including superficial, deep and organ/space surgical site infection, wound dehiscence, urinary tract infection, pneumonia, systemic sepsis and septic shock. Multivariate analyses were performed to assess the risk factors for post-operative infections.ResultsAll 10 100 eligible patients were included and 611 (6.0%) received perioperative BT. BT patients were older, lighter in weight and more likely to be functionally dependent. BT patients were more likely to have post-operative infectious complications than those without BT, including superficial surgical site infection (SSI) (10.8% vs 7.4%, p=0.002), deep SSI (3.3% vs 1.6%, p=0.003), organ/space SSI (14.2% vs 5.4%, p<0.001), pneumonia (3.8% vs 1.3%, p<0.001), urinary tract infection (3.9% vs 2.2%, p=0.006), sepsis (11.5% vs 4.5%, p<0.001) and sepsis shock (3.1% vs 0.8%, p<0.001). Multivariate analysis showed that intra- and/or post-operative BT was an independent risk factor for post-operative infectious complications (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.8–2.7; p<0.001) and the risk increased with each administered unit of red blood cell (OR = 1.3, 95% CI: 1.2–1.5). Other independent factors were history of smoking, chronic heart disease, diabetes, hypertension and the use of corticosteroids. Pre-operative BT, however, was not found to be a risk factor to post-operative infections.Conclusions Intra- and/or post-operative, not pre-operative, BT was found to be associated with an increased risk for post-operative infectious complications in this CD cohort. Therefore, the timing and risks and benefits of BT should be carefully balanced.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

Stocchi

et al. 2017

Gastroenterology Report

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“…Narcotic use in IBD patients has been linked to a number of adverse effects, including higher rate of infectious complications, surgical complications and even mortality. 24–26 Thus, further research is needed to understand the nature of pain in CD patients with ostomy and provide appropriate alternatives to narcotic-based analgesia in this population.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Ostomy on Quality of Life and Functional Status of Crohnʼs Disease Patients

Abdalla

Sandler

Kappelman

et al. 2016

Inflammatory Bowel Diseases

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Background The potential need for an ostomy is a main concern for patients with inflammatory bowel disease. We performed this study to evaluate the impact of a long term ostomy (≥ 6 months duration) on the functional status and specific patient-reported outcomes (PRO) in a population of patients with Crohn’s disease (CD). Methods We performed a cross-sectional analysis within the CCFA Partners cohort Study. Bivariate analyses and logistic regression models were used to investigate associations between ostomy and various demographic, disease factors, and PROs for health related quality of life (HRQOL). Results A total of 402 CD patients with ostomy for a minimum duration of 6 months were compared to 4331 CD patients with no ostomy. Patients with ostomy were more likely to be in clinical remission compared to those without ostomy, 48.5% vs. 31.3%, respectively. Having an ostomy did not impact overall HRQOL and was not associated with anxiety, depression, sleep disturbances, or reduced sexual interest and satisfaction. However, the presence of ostomy was associated with reduced social role satisfaction in patients both with controlled and active disease. Additionally, in the subset of patients who did not achieve clinical remission, those with ostomy experienced greater pain interference (OR 1.63, 95% CI 1.12–2.35) and fatigue (OR 1.66 95% CI 1.15–2.39). Conclusion Ostomy is well-tolerated in CD patients, particularly when clinical remission is achieved.

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“…Third, longer durations of opioid use can paradoxically worsen abdominal pain symptoms and may lead to opioid bowel dysfunction and narcotic bowel syndrome [38]. Finally, for patients with IBD, increased opioid use is associated with decreased quality of life, and increases in 30-day hospital readmissions, serious infections and complications [39–41]. …”

Section: Introductionmentioning

confidence: 99%

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

Balbale

Trivedi²,

O’Dwyer

et al. 2017

Dig Dis Sci

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Background Scoping reviews are preliminary assessments intended to characterize the extent and nature of emerging research evidence, identify literature gaps, and offer directions for future research. We conducted a systematic scoping review to describe published scientific literature on strategies to identify and reduce opioid misuse among patients with gastrointestinal (GI) symptoms and disorders. Methods We performed structured keyword searches to identify manuscripts published through June 2016 in the PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases to extract original research articles that described health care practices, tools or interventions to identify and reduce opioid misuse among GI patients. The Chronic Care Model (CCM) was used to classify the strategies presented. Results Twelve articles met the inclusion criteria. A majority of studies used quasi-experimental or retrospective cohort study designs. Most studies addressed the CCM’s clinical information systems element. Seven studies involved identification of opioid misuse through prescription drug monitoring and opioid misuse screening tools. Four studies discussed reductions in opioid use by harnessing drug monitoring data and individual care plans, and implementing self-management and opioid detoxification interventions. One study described drug monitoring and an audit-and-feedback intervention to both identify and reduce opioid misuse. Greatest reductions in opioid misuse were observed when drug monitoring, self-management, or audit-and-feedback interventions were used. Conclusions Prescription drug monitoring and self-management interventions may be promising strategies to identify and reduce opioid misuse in gastrointestinal care. Rigorous, empirical research is needed to evaluate the longer-term impact of these strategies.

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Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn’s Disease Patients

Abstract: Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CD patients undergoing ostomy creation. These findings may influence risk management of CD patients needing ostomies.

Cited by 15 publications

References 31 publications

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

The Impact of Ostomy on Quality of Life and Functional Status of Crohnʼs Disease Patients

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

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