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PWE-259 Colorectal cancer (CRC) patients with inflammatory bowel disease (IBD) are at increased risk of poor outcomes post surgery in england
  1. A Askari1,
  2. S Nachiappan1,
  3. J Murphy2,
  4. S Mills3,
  5. A Bottle4,
  6. T Athanasiou5,
  7. N Arebi6,
  8. S Clark2,
  9. O Faiz1
  1. 1Surgical Epidemiology, Trials and Outcomes Centre
  2. 2Department of Surgery, St. Mark–s Hospital, Imperial College London
  3. 3Department of Surgery, Chelsea and Westminster Hospital
  4. 4Dr Foster Health, Imperial College London
  5. 5Surgery and Cancer, St. Mary–s Hospital, Imperial College London
  6. 6Department of Gastroentrology, St. Mark–s Hospital, Imperial College London, London, UK

Abstract

Introduction Colorectal cancer (CRC) patients with Ulcerative Colitis (UC) and Crohn’s Disease (CD) can be challenging to manage in the perioperative period. The aim of this study is to examine differences between Inflammatory Bowel Disease (IBD) and sporadic CRC patients in terms of the emergency admission rates, length of stay and post operative complications.

Method A national study was carried out using the Hospital Episode Statistics (HES) database between the years of 1997 to 2012. Multivariable binary logistic regression was undertaken to determine whether IBD was independently associated with the development of a postoperative complication.

Results During the study time period, 286,591 patient underwent colorectal cancer resection, 0.8% of which (n = 2,322) had IBD. A greater proportion of IBD patients underwent a colorectal cancer resection as an emergency than sporadic patients (UC 25.1%, CD 34.7% and sporadic 24.3%, p < 0.001). IBD patients had a significantly prolonged length of stay after elective surgery for CRC (median number of days length of stay 10 vs. 7, p = 0.001). The overall rate of serious medical complication such as myocardial infarction, stroke, pulmonary embolism was 7.8%, the overall rate of 30-day re-operation was 4.2% (n = 11,987) with a further 0.6% (n = 1,633) requiring radiological re-intervention. A diagnosis of IBD (adjusted for age, gender, comorbidity, mode of admission and type of operation) was an independent predictor of 30-day re-operation (OR 1.32, CI 1.12–1.56, p = 0.001).

Conclusion IBD patients, particularly Crohn’s patients commonly have their colorectal cancer resected in an emergency setting. IBD patients are more likely to require 30-day re-intervention, irrespective of other factors. A multi-disciplinary team approach incorporating surgeons, gastroenterologists, anaesthetists and radiologists is essential in the management of these complex patients in the peri-operative period

Disclosure of interest None Declared.

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