Abstract
BACKGROUND: In patients with inflammatory bowel disease (IBD) who need intestinal resection, prior data suggest that earlier surgical intervention may be associated with improved outcomes. However, surgery is often deferred for additional trials of advanced therapies, which potentially shifts patients from a fit to a frail preoperative state. OBJECTIVES: This study aimed to evaluate clinical changes that occur in the year prior to intestinal resection in patients with IBD. DESIGN: Retrospective cohort study. METHODS: This was a multi-hospital retrospective study of patients ⩾18 years old who underwent initial IBD-related intestinal resection between January 1, 2018 and May 31, 2023. Clinical characteristics and radiographical skeletal muscle mass were compared using the Wilcoxon Signed-Rank test for continuous variables and McNemar's test for categorical variables. RESULTS: A total of 170 patients were included (120 with Crohn's disease, 40 with ulcerative colitis, and 10 with indeterminate colitis), with a median disease duration of 7.4 years (interquartile range (IQR) 3.3-13.8). Median age at surgery was 32.6 years (IQR 25.9-44.9), and 51% were female. In the month prior to surgery as compared to the 6-12 months prior, individuals were more likely to have an IBD-related hospitalization (31% vs 5%, p < 0.01), malnutrition (30% vs 18%, p < 0.01), or an infection (74% vs 28%, p < 0.01). Though not statistically significant, there was an increase in the proportion of individuals who developed a venous thromboembolism in the month prior to surgery, and a decrease in skeletal muscle mass among those with two computerized tomography scans in the year prior to surgery (n = 6, 126 vs 111 cm2; p = 0.06). CONCLUSION: In the 6-12 months prior to an IBD-related intestinal resection, as compared to the month prior, individuals were less likely to be malnourished, have an infection, or need hospitalization for IBD. This suggests that minimizing delays to surgery may lead to improved outcomes.