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Postoperative Complications and Emergent Readmission in Children and Adults with Inflammatory Bowel Disease Who Undergo Intestinal Resection: A Population-based Study

Frolkis, Alexandra BSc*; Kaplan, Gilaad G. MD, MPH*; Patel, Alka B. PhD*; Faris, Peter PhD*; Quan, Hude PhD*; Jette, Nathalie MD, MSc*,†,‡; deBruyn, Jennifer MD, MSc§

doi: 10.1097/MIB.0000000000000099
Original Clinical Articles

Background: Although the nature and frequency of postoperative complications after intestinal resection in patients with inflammatory bowel disease have been previously described, short-term readmission has not been characterized in population-based studies. We therefore assessed the risk of postoperative complications and emergent readmissions after discharge from an intestinal resection.

Methods: We used a Canadian provincial-wide inpatient hospitalization database to identify 2638 Crohn's disease (CD) and 559 ulcerative colitis (UC) admissions with intestinal resection from 2002 to 2011. We identified the cumulative risk of in-hospital complication and emergent readmission within 90 days after discharge along with predictors for both outcomes using a Poisson regression for binary outcomes.

Results: The cumulative risks of in-hospital postoperative complications and 90-day emergent readmission were 23.8% and 12.6%, respectively in CD and 33.3% and 11.1%, respectively in UC. The predictors for in-hospital postoperative complications for CD and UC included older age, comorbidities, and open laparatomy for CD, additional predictors included emergent admission, stoma surgery, and concurrent resection of both small and large bowel. The predictors for 90-day readmission for CD included a postoperative complication (risk ratio, 1.61; 95% confidence interval, 1.30–2.01), emergent admission (risk ratio, 1.39; 95% confidence interval, 1.12–1.73), and stoma formation (risk ratio, 1.49; 95% confidence interval, 1.15–1.93) at the hospitalization requiring surgery.

Conclusions: Readmission and postoperative complications are common after intestinal resection in CD and UC. Clinicians should closely monitor surgical patients who required emergent admission, undergo surgery with stoma formation, or develop in-hospital postoperative complications to anticipate need for readmission or interventions to prevent readmission.

Article first published online 30 June 2014.

*Department of Community Health Sciences and Institute for Public Health,

Department of Medicine,

Department of Clinical Neurosciences and Hotchkiss Brain Institute, and

§Department of Paediatrics, University of Calgary, Calgary, AB, Canada.

Reprints: Jennifer deBruyn, MD, MSc, Department of Paediatrics, University of Calgary, Alberta Children' Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada (e-mail: jennifer.debruyn@albertahealthservices.ca).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

A. Frolkis is supported by an Alberta-Innovates Health Solutions studentship. Dr. G. G. Kaplan is supported through a New Investigator Award from the Canadian Institute of Health Research and a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research. Dr. N. Jette is supported by a Population Health Investigator Award from Alberta-Innovates Health Solutions and a Canada Research Chair in Neurological Health Services Research. Dr. H. Quan is supported by Alberta-Innovates Health Solutions. J. deBruyn has participated in advisory board meetings for Merck and Janssen and has received research grant support and travel support from Janssen. G. G. Kaplan has served as a speaker for Janssen and Abbott. He has participated in advisory board meetings for Abbott, Merck, Janssen, and Shire. Dr. G. G. Kaplan has received research support from Merck, Abbott and Shire. The remaining authors have no conflicts of interest to disclose.

Received March 11, 2014

Accepted April 30, 2014

© Crohn's & Colitis Foundation of America, Inc.
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