Surgery for Ulcerative Colitis in Elderly Persons

Almogy, Gidon; Sachar, David B.; Bodian, Carol; Greenstein, Adrian J.

doi:10.1001/archsurg.136.12.1396

Cited by 44 publications

(9 citation statements)

References 17 publications

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“…Postoperative complications after surgery decreased from the years 1960–1984 to 1994–1999 and elderly age was not a predictor of adverse outcome. 69 There was no significant difference in morbidity or 30-day mortality between TPCI versus IPAA procedures. 70 The incidence of postoperative cardiac and pulmonary complications was higher in the elderly than in younger patients.…”

Section: Ibd Treatment In the Elderlymentioning

confidence: 81%

Management of inflammatory bowel disease in older persons: evolving paradigms

2018

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The incidence and prevalence of inflammatory bowel disease (IBD) is increasing, and considering the aging population, this number is set to increase further in the future. The clinical features and natural history of elderly-onset IBD have many similarities with those of IBD in younger patients, but with significant differences including a broader differential diagnosis. The relative lack of data specific to elderly patients with IBD, often stemming from their typical exclusion from clinical trials, has made clinical decision-making somewhat challenging. Treatment decisions in elderly patients with IBD must take into account age-specific concerns such as comorbidities, locomotor and cognitive function, and polypharmacy, to set realistic treatment targets in order to enable personalized treatment and minimize harm. Notwithstanding paucity of clinical data, recent studies have provided valuable insights, which, taken together with information gleaned from previous studies, can broaden our understanding of IBD. These insights may contribute to the development of paradigms for the holistic and, when possible, evidence-based management of this potentially vulnerable population and are the focus of this review.

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Section: Ibd Treatment In the Elderlymentioning

confidence: 81%

Management of inflammatory bowel disease in older persons: evolving paradigms

2018

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“…Although older patients were thought to have higher rates of complications, while the mortality rates of patients requiring urgent surgery have been reported at as high as 50 % [10–12], the number of elderly patients in those studies was small. Moreover, Almogy et al [13] reported emergency surgery, a low level of albumin, and male sex as predictors of an adverse outcome in their elderly UC population. Fewer complications and a lower death rate should be expected in elderly UC patients undergoing elective procedures.…”

Section: Discussionmentioning

confidence: 99%

Prognosis following emergency surgery for ulcerative colitis in elderly patients

et al. 2013

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PurposeSince 2000, the incidence of ulcerative colitis (UC) in patients over 60 years old has been rapidly increasing. We reviewed our surgical experience of elderly patients with UC treated at our hospital.MethodsPatients aged 60 years or older at the time of surgery were defined as “elderly”. The medical records of all elderly patients who underwent surgery for UC during a 26-year period were retrospectively analyzed.ResultsThe prognosis of elderly patients who underwent emergency surgery was extremely poor: 8 (26.7 %) of 30 such patients died within 30 postoperative days (PODs), whereas only 1 (0.88 %) of 114 who underwent elective surgery died within 30 PODs. Respiratory tract infection and sepsis resulting from methicillin-resistant Staphylococcus aureus or mycotic infection were the most common causes of death after emergency surgery.ConclusionThe prognosis of elderly UC patients undergoing emergency surgery is very poor; thus, physicians and surgeons should collaborate to treat severe and fulminant disease, to optimize the timing of surgery. Early decisions about emergency surgery for UC will reduce postoperative mortality, especially in elderly patients.

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“…These clinical considerations seem to be partially confirmed by the experience of Almogy et al [3]: in their series of elderly patients, in fact, they showed that TM is still associated with a high mortality rate (37.5%) which has not improved over time.…”

Section: Discussionmentioning

confidence: 72%

“…The lifetime risk of TM in patients with IBD has gradually decreased probably because of earlier diagnosis and more aggressive management of severe colitis [2, 3]. On the other hand, TM as a complication of infectious colitis is expected to increase [4] in proportion to the rapidly rising prevalence of pseudomembranous (due to broad-spectrum antibiotics) and CMV (due to HIV infection or immunosuppression) colitis.…”

Section: Introductionmentioning

confidence: 99%

Early Surgery for the Treatment of Toxic Megacolon

et al. 2005

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Background: Toxic megacolon (TM) is a potentially lethal complication of idiopathic inflammatory bowel disease or infectious colitis, characterized by total or segmental non-obstructive colonic dilatation of at least 6 cm associated with systemic toxicity. Methods: Overall, 15 patients had surgery for TM at our institutions over a 10-year period (1993–2003). In contrast to other studies that used medical therapy as the first-line treatment for TM, in our experience all patients underwent surgery as soon as possible after diagnosis of TM (early surgery). Results: 14 patients underwent subtotal colectomy with terminal ileostomy, while for 1 patient the surgical procedure consisted only in a decompressive cecostomy. Two major complications occurred consisting of 2 cases of multiple organ failure leading to death. No other major complications or deaths were reported. The overall mortality rate was therefore 13% (0% in patients <65 years). Conclusion: This study shows that early surgery has the potential to represent a valid therapeutic strategy for patients with TM resulting in a small number of TM-related complications and deaths. Elderly patients seem to have a high risk of multiple organ dysfunction syndrome and post-surgical death.

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Surgery for Ulcerative Colitis in Elderly Persons

Cited by 44 publications

References 17 publications

Management of inflammatory bowel disease in older persons: evolving paradigms

Management of inflammatory bowel disease in older persons: evolving paradigms

Prognosis following emergency surgery for ulcerative colitis in elderly patients

Early Surgery for the Treatment of Toxic Megacolon

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