| Does preoperative immunosuppression influence unplanned hospital readmission after surgery in patients with Crohn's disease? | |
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MedLine Citation:
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PMID: 22513435 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: : Steroids, immunomodulators, and biologics, often in combination with one another, are frequently used in the treatment of Crohn's disease. Retrospective studies have yielded conflicting results regarding the influence of preoperative immunosuppressive therapy on postoperative complications after surgery in Crohn's disease. Unplanned hospital readmission is considered to be an index of quality surgical care. OBJECTIVE: : The aim of this study was to examine the association, if any, between the number of preoperative immunosuppressive therapies and unplanned hospital readmission after surgery in patients with Crohn's disease. DESIGN: : Consecutive patients with Crohn's disease requiring abdominal surgery were identified from a prospectively maintained database. Preoperative immunosuppressive therapy within 3 months before surgery was categorized into 3 classes: steroids, immunomodulators, and biologics. MAIN OUTCOME MEASURES: : Unplanned readmission occurring within 30 days of hospital discharge was assessed. Trend analysis was performed with the use of the Cochrane-Armitage test. RESULTS: : The study group included 338 patients. Preoperative medical therapy included steroids (n = 199; 59%), immunomodulators (n = 162; 48%), and biologics (n = 59; 18%). Sixty-three patients (19%) were not treated with any immunosuppressive medications preoperatively, whereas 148 patients (44%), 108 patients (32%), and 19 patients (6%) were treated with 1, 2, or 3 classes of immunosuppressive medications. Twenty-eight patients (8.3%) had an unplanned readmission. The incidence of unplanned readmission was similar among patients treated with steroids (11%), immunomodulators (9%), and biologics (12%). The incidence of unplanned readmission was 3%, 7%, 11%, and 16% in patients treated with 0, 1, 2, or 3 preoperative medication classes (trend analysis p = 0.02). No significant differences were observed between patient groups treated with 0, 1, 2, or 3 preoperative immunosuppressive therapies with respect to patient, disease, or surgical factors. CONCLUSIONS: : Unplanned hospital readmission occurs frequently (8.3%) after surgery for Crohn's disease. Combination immunosuppressive therapy before surgery in patients with Crohn's disease appears to be associated with an increased incidence of postoperative unplanned hospital readmission. |
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Authors:
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Evan C White; Gil Y Melmed; Eric Vasiliauskas; Marla Dubinsky; Andrew Ippoliti; Dermot McGovern; Stephan Targan; Phillip Fleshner |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 55 ISSN: 1530-0358 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-04-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
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Languages: eng Pagination: 563-8 Citation Subset: IM |
Affiliation:
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1Division of Colon and Rectal Surgery, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 2Department of Gastroenterology, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 3Division of Pediatric Gastroenterology, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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