Elsevier

Journal of Pediatric Surgery

Volume 53, Issue 12, December 2018, Pages 2440-2443
Journal of Pediatric Surgery

Colorectal
The burden of surgery and postoperative complications in children with inflammatory bowel disease

https://doi.org/10.1016/j.jpedsurg.2018.08.030Get rights and content

Abstract

Background

Pediatric inflammatory bowel disease (IBD) may be associated with a higher burden of surgery and postoperative complications. This study aimed to measure the burden in pediatric IBD over a 20-year period in a large tertiary referral center.

Methods

A retrospective review was conducted of children diagnosed with IBD between 1996 and 2015, with a focus upon operative intervention (excluding endoscopy) and postoperative outcomes.

Results

Of 786 IBD patients, 121/581 (20.8%) with Crohn's disease (CD) and 22/205 (10.7%) with ulcerative colitis (UC) underwent surgery during the study period. When comparing 10-year epochs for CD, median time from diagnosis to intervention decreased from 34 months to 3 months (P < 0.0001). Postoperative complications occurred in 16/121 (13%) CD patients (bowel obstruction: 10, anastomotic stricture: 4, stomal issues: 4, anastomotic leak: 1). Within the UC cohort, the median time from diagnosis to intervention decreased from 62 months to 6 months (P = 0.0019). Postoperative complications occurred in 9/22 (41%) UC patients (bowel obstruction: 7, stomal issues: 3, anastomotic stricture: 1). Compared with CD, complications were more frequent in UC patients (P = 0.004).

Conclusion

Surgery and postoperative complications are common in pediatric IBD. The timing of intervention has trended towards earlier operations in both CD and UC.

Level of evidence

Treatment study—level III (retrospective comparative study).

Section snippets

Selection of patients

Patients diagnosed with IBD at our pediatric tertiary referral center over a 20-year period (1996–2015) were identified and surveilled for operative intervention (excluding endoscopy). Patients were identified from the prospectively-collected departmental IBD database, as well as by accessing surgical admission codes. A retrospective chart review was conducted, with data collected regarding diagnosis, medical and operative management.

Patients were classified into Crohn's disease (CD),

Demographics

A total of 143 children satisfied the inclusion criteria during the study period (Table 1). This represented 18.2% (143/786) of all patients with a definitive diagnosis of IBD managed at our center during the same period. The median age at diagnosis in the surgical cohort was 11.5 (3.0–16.7), and the majority (77/143, 53.8%) were male. The median age at diagnosis in the nonsurgical cohort was 12.2 (0.9–17.4). The median time from definitive IBD diagnosis to first surgical intervention was

Discussion

This study explores the surgical burden and postoperative complications of pediatric IBD in a large tertiary center over a 20-year period (1996–2015). The current study is one of the largest single center studies on this subject. The demographics and phenotype of both CD and UC are consistent with previous studies, with an overall slight predominance of males to females [4], [5].

The role of surgery for CD is not curative, but rather to alleviate symptoms and disease complications. As a result,

Acknowledgments

Associate Professor Sebastian King is the grateful recipient of a Career Development Award (Murdoch Children's Research Institute) and the Senior Lecturer Fellowship (Royal Australasian College of Surgeons). His position as an Academic Pediatric Surgeon is possible owing to a generous grant from The Royal Children's Hospital Foundation.

Associate Professor Warwick Teague's position as an Academic Pediatric Surgeon and Director of Trauma Services is generously supported by The Royal Children's

References (12)

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Disclosures.

Ethics: RCH HREC DB087.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosures: The authors have no conflict of interest to declare.

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