ColorectalThe burden of surgery and postoperative complications in children with inflammatory bowel disease☆
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
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Cited by (13)
Age- and Sex-Specific Needs for Children Undergoing Inflammatory Bowel Disease Surgery: A Qualitative Study
2022, Journal of Surgical ResearchCitation Excerpt :More than one in every four new diagnoses of IBD are made during childhood or adolescence,4,5 and the prevalence of IBD is rising most substantially among children between the ages of 10 and 17 y.3,6 Although medical therapies to treat IBD have expanded and typically comprise first-line treatment,7,8 approximately 20%-30% of children with IBD require surgery within 10 y of diagnosis to achieve remission after failing multiple medical therapies.9-11 A significant proportion of children with IBD will subsequently undergo additional surgical intervention, given the increased risk of postoperative disease recurrence and complications.12-14 This can contribute to an increasingly complex surgical course as well as extensive health care use and cost and underscores the need to optimize surgical care and outcomes for this patient population.15-17
Outcomes of Initial Subtotal Colectomy for Pediatric Inflammatory Bowel Disease
2020, Journal of Surgical ResearchOutpatient follow-up after pediatric surgery reduces emergency department visits and readmission rates
2020, Journal of Pediatric SurgerySingle-center review of staged restorative proctectomy for ulcerative colitis
2020, Journal of Pediatric SurgeryCitation Excerpt :In a recent Finnish study of staged ileoanal anastomosis, 55% had complications and of 87 patients 43% required re-laparotomy, most commonly for adhesive SBO [7]. In an Australian study over a similar time period, 45% had re-laparotomy of which 23% were for SBO [8]. Similarly, Ashton et al. from the UK encountered early and late complications following colectomy of 47% and 32% respectively, the commonest of which was SBO [9], although none of the 20% of their patients having laparoscopic colectomy (20%) in their series had yet developed SBO.
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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.