Original Article

Effects of the COVID-19 Pandemic on Colectomy Outcomes for Inflammatory Bowel Disease

Authors: Satyam K. Ghodasara, BS, Justin S. Roskam, BS, Michael Uretsky, BS, Grace C. Chang, DO, Rolando H. Rolandelli, MD, Zoltan H. Nemeth, MD, PhD

Abstract

Objectives: Inflammatory bowel disease (IBD) encompasses Crohn’s disease (CD) and ulcerative colitis (UC). These two chronic inflammatory conditions can differ in severity, presentation, and anatomical localization, and can greatly affect quality of life if not managed properly. Given the many healthcare challenges during the coronavirus disease 2019 pandemic, we studied the effects of the pandemic and corresponding changes to medical resources on surgical outcomes for patients with IBD.

Methods: Deidentified data from patients who underwent a colectomy for CD or UC were collected from the National Surgical Quality Improvement Program database of the American College of Surgeons. We analyzed clinical factors and surgical outcomes between 2019 and 2020.

Results: Patients with IBD were more likely to have lost >10% of their body mass before the operation in 2020. Operations for patients with UC were significantly shorter in the first year of the pandemic. Patients with CD were less likely to have a urinary tract infection or sepsis postoperatively in 2020, whereas patients with UC were more likely to require a repeat operation. Interestingly, both patient populations were less likely to undergo an emergency operation in 2020 than in 2019.

Conclusions: Colectomy outcomes for patients with CD in 2020 were similar or improved in comparison with those seen in 2019, whereas colectomies for UC saw a statistically but not clinically significant increase in the rate of repeat operations. Overall, these patients seem to have been well managed despite the coronavirus disease 2019 pandemic–induced strain on the healthcare system.
Posted in: Gastroenterology51

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Fakhoury M, Negrulj R, Mooranian A, et al. Inflammatory bowel disease: clinical aspects and treatments. J Inflamm Res 2014;7:113.
 
2. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2017;390:2769–2778.
 
3. Subasinghe D, Nawarathna NMM, Samarasekera DN. Disease characteristics of inflammatory bowel disease (IBD). J Gastrointest Surg 2011;15:1562–1567.
 
4. Lees CW, Regueiro M, Mahadevan U. Innovation in IBD care during the COVID-19 pandemic: results of a global telemedicine survey by the international organization for the study of inflammatory bowel disease. Gastroenterology 2020;159:805–808.
 
5. Lockey SD, Nelson PC, Kessler MJ, et al. Approaching “elective” surgery in the era of COVID-19. J Hand Surg 2021;46:60–64.
 
6. Raval MV, Pawlik TM. Practical guide to surgical data sets: National Surgical Quality Improvement Program (NSQIP) and pediatric NSQIP. JAMA Surg 2018;153:764–765.
 
7. Damas OM, Garces L, Abreu MT. Diet as adjunctive treatment for inflammatory bowel disease: review and update of the latest literature. Curr Treat Options Gastroenterol 2019;17:313–325.
 
8. Tao SS, Wang XY, Yang XK, et al. COVID-19 and inflammatory bowel disease crosstalk: from emerging association to clinical proposal. J Med Virol 2022;94:5640–5652. .
 
9. Shah KP, Triana AJ, Gusdorf RE, et al. Demographic factors associated with successful telehealth visits in inflammatory bowel disease patients. Inflammatory Bowel Diseases. 2021;28:358–363.
 
10. Smith J, Liu C, Beck A, et al. Racial disparities in pediatric inflammatory bowel disease care: differences in outcomes and health service utilization between Black and White children. J Pediatr 2023;260:113522.
 
11. Aghagoli G, Gallo Marin B, Soliman LB, et al. Cardiac involvement in COVID-19 patients: risk factors, predictors, and complications: a review. J Card Surg 2020;35:1302–1305.
 
12. Meador M, Coronado F, Roy D, et al. Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers. BMC Public Health 2022;22:2295.
 
13. Iheanacho CO, Odili VU, Eze UIH. Risk of SARS-CoV-2 infection and COVID-19 prognosis with the use of renin-angiotensin-aldosterone system (RAAS) inhibitors: a systematic review. Futur J Pharm Sci. 2021;7:73.
 
14. Glowacka I, Bertram S, Herzog P, et al. Differential downregulation of ACE2 by the spike proteins of severe acute respiratory syndrome coronavirus and human coronavirus NL63. J Virol 2010;84:1198–1205.
 
15. Banerji A, Blumenthal KG, Lai KH, et al. Epidemiology of ACE inhibitor angioedema utilizing a large electronic health record. J Allergy Clin Immunol Pract 2017;5:744–749.
 
16. Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum. J Gastrointest Surg 2009;13:1009–1016.
 
17. Niriella MA, Liyanage IK, Kodisinghe SK, et al. Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study. BMC Gastroenterol 2021;21:71.
 
18. Soliman SS, Nemeth ZH, Stopper PB, et al. Letter in response to Hossain, N, et al “Hospital presentations of acute diverticulitis during COVID-19 pandemic may be more likely to require surgery due to increased severity: a single-centre experience.” Am Surg 2021;29:31348211029869.
 
19. Hossain N, Naidu V, Hosny S, et al. Hospital presentations of acute diverticulitis during COVID-19 pandemic may be more likely to require surgery due to increased severity: a single-centre experience. Am Surg 2020;86:3134820982560.
 
20. Wong LE, Hawkins JE, Langness S, et al. Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care. NEJM Catalyst 2020;1:1–12.
 
21. Cao Y, Li Q, Chen J, et al. Hospital emergency management plan during the COVID-19 epidemic. Acad Emerg Med 2020;27:309–311.
 
22. Deputy M, Sahnan K, Worley G, et al. The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study. Aliment Pharmacol Therap 2022;55:836–846.
 
23. Pang L, Liu H, Liu Z, et al. Role of telemedicine in inflammatory bowel disease: systematic review and meta-analysis of randomized controlled trials. J Med Internet Res 2022;24:e28978.
 
24. De Simone B, Davies J, Chouillard E, et al. WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting. World J Emerg Surg 2021;16:23.