IBD patients see improvements after surgical intervention

A surgical intervention performed for inflammatory bowel disease (IBD) appears to confer favourable effects on patient-reported outcomes such as pain and overall health, according to a prospective, longitudinal cohort study.

Postoperative survey data collected from patients a month after the operation showed a significant 1-point decrease in the pain level experienced within the past 7 days, from a median of 3 at baseline to a median of 2 at day 30 (p=0.04). [CCC 2024, poster 028]

There was a substantial increase in the proportion of patients reporting “good to excellent” overall health (from 67.0 percent to 83.0 percent; p=0.04) and physical health (from 59.0 percent to 77.8 percent; p=0.03), with fewer days feeling unwell (p=0.02) and bloated (p=0.04) and having faecal urgency (p=0.0007).

Likewise, significantly fewer patients reported having moderate to very severe fatigue at day 30 than at baseline (53.7 percent vs 71.1 percent; p=0.05).

Ongoing recovery

Other patient-reported outcomes remained largely unchanged after the surgical intervention. The respective proportions of patients rating an outcome “good to excellent” at baseline and at day 30 were 73.9 percent and 83.0 percent for quality of life (p=0.27), 74.0 percent and 70.4 percent for mental health (p=0.68), 65.0 percent and 68.5 percent for social satisfaction (p=0.70), and 61.0 percent and 64.8 percent for the ability to perform socially (p=0.65).

Furthermore, the prevalence of the following did not significantly differ between baseline and day 30: experiencing emotional problems “sometimes to always” within the past 7 days (70.0 percent and 53.7 percent; p=0.07), feeling upset “most to all of the time” (19.4 percent and 9.8 percent; p=0.15), and bowel issues preventing socializing “most to all of the time” (25.7 percent and 25.4 percent; p=0.46).

The only negative change associated with IBD surgery was the patients’ ability to perform daily activities, with the proportion of patients reporting a “poor to fair” ability jumping from 17.4 percent preoperatively to 37.0 percent postoperatively (p=0.01).

“Our data suggest patients are still recovering 30 days after surgery, and longer follow-up may reveal further improvements,” according to lead study author Dr Stefan Holubar of the Cleveland Clinic in Cleveland, Ohio, US.

“Targeted psychosocial interventions and support at home early in the acute postoperative period may improve the quality of recovery after surgery for patients with IBD,” Holubar added.

For the study, Holubar and colleagues enrolled 103 adult patients (median age 43 years, 49 percent women) undergoing major abdominopelvic surgery for a known diagnosis of IBD. Of these patients, 64 percent had Crohn’s disease, 35 percent had ulcerative colitis, and 1 percent had unknown IBD.

A total of 69 (67 percent) patients completed the preoperative survey, and 58 (56 percent) completed the postoperative survey. Patient-reported outcomes were assessed using the PROMIS General Health measures; PROMIS Pain Interference, Fatigue, and Sleep scales; and the Crohn’s & Ulcerative Colitis Questionnaire.