Restorative Surgery Is More Common in Ulcerative Colitis Patients With a High Income: A Population-Based Study
| Autor: | Caroline Nordenvall, Karin Westberg, Ola Olén, Åsa H Everhov, Pär Myrelid, Jonas Halfvarson, Jonas F. Ludvigsson, Jonas Söderling |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Risk Assessment Restorative surgery Cohort Studies Young Adult Outcome Assessment Health Care Humans Medicine Treatment Failure Healthcare Disparities Colectomy Sweden Gynecology Ileostomy business.industry Proctocolectomy Restorative Gastroenterology General Medicine Middle Aged medicine.disease Ulcerative colitis Population based study Social Class Case-Control Studies Income Colitis Ulcerative Female business |
| Zdroj: | Diseases of the Colon & Rectum. 64:301-312 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0000000000001775 |
| Popis: | BACKGROUND To avoid a permanent stoma, restorative surgery is performed after the colectomy. Previous studies have shown that less than half of patients with ulcerative colitis undergo restorative surgery. OBJECTIVE The primary aim was to explore the association between socioeconomic status and restorative surgery after colectomy. DESIGN This was a nationwide register-based cohort study. SETTINGS The study was conducted in Sweden. PATIENTS All Swedish patients with ulcerative colitis who underwent colectomy between 1990 and 2017 at the age of 15 to 69 years were included. MAIN OUTCOME MEASURES The main outcome was restorative surgery, and the secondary outcome was failure of the reconstruction (defined as the need for a new ileostomy after the reconstruction or nonreversal of a defunctioning stoma within 2 years of the reconstruction). To calculate HRs for restorative surgery after colectomy, as well as failure after restorative surgery, multivariable Cox regression models were performed (adjusted for sex, year of colectomy, colorectal cancer diagnosis, education, civil status, country of birth, income (quartiles 1 to 4, where Q4 represents highest income), hospital volume, and stratified by age). RESULTS In all, 5969 patients with ulcerative colitis underwent colectomy, and of those, 2794 (46.8%) underwent restorative surgery. Restorative surgery was more common in patients with a high income at the time of colectomy (quartile 1, reference; quartile 2, 1.09 (0.98-1.21); quartile 3, 1.20 (1.07-1.34); quartile 4, 1.27 (1.13-1.43)) and less common in those born in a Nordic country than in immigrants born in a non-Nordic country (0.86 (0.74-0.99)), whereas no association was seen with educational level and civil status. There was no association between socioeconomic status and the risk of failure after restorative surgery. LIMITATIONS The study was restricted to register data. CONCLUSIONS Restorative surgery in ulcerative colitis appears to be more common in patients with a high income and patients born in a non-Nordic country, indicating inequality in the provided care. See Video Abstract at http://links.lww.com/DCR/B433. LA CIRUGA RESTAURADORA ES MS COMN EN PACIENTES CON COLITIS ULCEROSA CON INGRESOS ALTOS UN ESTUDIO POBLACIONAL ANTECEDENTES:Para evitar un estoma permanente, se realiza una cirugia reparadora despues de la colectomia. Estudios anteriores han demostrado que menos de la mitad de los pacientes con colitis ulcerosa se someten a cirugia reconstituyente.OBJETIVO:El objetivo principal fue explorar la asociacion entre el nivel socioeconomico y la cirugia reconstituyente despues de la colectomia.DISENO:Estudio de cohorte basado en registros a nivel nacional.MARCO:Suecia.PACIENTES:Todos los pacientes Suecos con colitis ulcerosa que se sometieron a colectomia desde el 1990 a 2017 a la edad de 15 a 69 anos.MEDIDAS DE RESULTADOS PRINCIPALES:El resultado principal fue la cirugia restaurativa y el resultado secundario fue el fracaso de la reconstruccion (definida como la necesidad de una nueva ileostomia despues de la reconstruccion o la no-reversion de un estoma disfuncional dentro de los dos anos posteriores a la reconstruccion). Para calcular los cocientes de riesgo para la cirugia restauradora despues de la colectomia, asi como el fracaso despues de la cirugia restauradora, se realizaron modelos de regresion de Cox multivariables (ajustados por sexo, ano de colectomia, diagnostico de cancer colorrectal, educacion, estado civil, pais de nacimiento e ingresos (cuartiles 1- 4; donde Q4 representa los mayores ingresos), volumen de hospitales y estratificado por edad).RESULTADOS:En total 5969 pacientes con colitis ulcerosa se sometieron a colectomia, y de ellos 2794 (46,8%) se sometieron a cirugia restauradora. La cirugia restauradora fue mas comun en pacientes con altos ingresos en el momento de la colectomia (referencia del cuartil 1, cuartil 2: 1,09 (0,98-1,21), cuartil 3: 1,20 (1,07-1,34), cuartil 4: 1,27 (1,13-1,43)), y menos comun en los nacidos en un pais nordico que en los inmigrantes nacidos en un pais no-nordico (0,86 (0,74-0,99)), mientras que no se observo asociacion con el nivel educativo y el estado civil. No hubo asociacion entre el nivel socioeconomico y el riesgo de fracaso despues de la cirugia reparadora.LIMITACIONES:Restriccion para registrar datos.CONCLUSIONES:La cirugia reparadora en colitis ulcerosa parece ser mas comun en pacientes con ingresos altos y en pacientes nacidos en un pais no-nordico, lo que indica desigualdad en la atencion brindada. Consulte Video Resumen en http://links.lww.com/DCR/B433. |
| Databáze: | OpenAIRE |
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