Purpose

Severe inflammatory colitis as a consequence of inflammatory bowel disease (IBD) may not be amenable to medical management, and surgery is often required. The optimal timing of surgery and perioperative therapeutic care requires a formal link between surgical department and gastroenterology which is often lacking. In this study, we assess the impact of adopting a multidisciplinary care bundle on complication rates of subtotal colectomy in IBD patients.

Methods

This is a single-centre retrospective observational study. Patients were identified through clinical discharge ICD10 codes. Clinical notes of patients who underwent subtotal colectomies from 1 January 2006 to 31 December 2019 were analysed. Socio-demographics, diagnosis, and medical and surgical management data were collected. A multimodule bundle, including weekly MDT discussions, was started in our unit on 1 April 2014. Multivariable logistic regression analysis was performed on these data.

Results

A total of 296 patients were identified with 113 patients of these (38.2%) experiencing a complication post operation. The overall complication rate improved over time (p = 0.023). Those patients treated after the initiation of the MDT bundle had reduced complication rates (44.6% versus 33.7%, p = 0.045). On multivariate analysis, increasing age (1.023 OR; 95% CI 1.004, 1.041) and procedure performed before MDT bundle (3.1 OR; 95% CI 1.689, 5.723) were independent predictors for post-operative complications.

Conclusions

Closer links between gastroenterology and colorectal specialties have improved patient outcomes in our unit. Whilst IBD MDTs have previously been shown to improve outcomes for patients managed medically, we demonstrate that this interaction, implemented as a multidisciplinary care bundle, also improves surgical outcomes.

中文翻译：

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通过采用多学科护理组合，改善因急性严重炎症性结肠炎而接受结肠切除术的患者的预后

 目的

炎症性肠病 (IBD) 导致的严重炎症性结肠炎可能无法进行药物治疗，通常需要手术治疗。手术和围手术期治疗护理的最佳时机需要外科部门和胃肠病学之间通常缺乏正式联系。在这项研究中，我们评估了采用多学科护理组合对 IBD 患者结肠次全切除术并发症发生率的影响。

 方法

这是一项单中心回顾性观察研究。通过临床出院 ICD10 代码识别患者。分析了2006年1月1日至2019年12月31日期间接受结肠次全切除术的患者的临床记录。收集了社会人口统计、诊断以及医疗和手术管理数据。 2014 年 4 月 1 日，我们单位开始了多模块捆绑，包括每周 MDT 讨论。对这些数据进行了多变量逻辑回归分析。

 结果

共有 296 名患者被确定，其中 113 名患者 (38.2%) 出现术后并发症。总体并发症发生率随着时间的推移而改善（ p = 0.023）。开始 MDT 集束治疗后接受治疗的患者并发症发生率降低（44.6% 对比 33.7%， p = 0.045）。在多变量分析中，年龄的增加（1.023 OR；95% CI 1.004, 1.041）和 MDT 捆绑前进行的手术（3.1 OR；95% CI 1.689, 5.723）是术后并发症的独立预测因素。

 结论

胃肠病学和结直肠专科之间更紧密的联系改善了我们科室的患者治疗效果。虽然 IBD MDT 先前已被证明可以改善医疗管理患者的结果，但我们证明，作为多学科护理组合实施的这种相互作用也可以改善手术结果。