LAS VEGAS — Patients who underwent surgery for inflammatory bowel disease (IBD) reported feeling physically better, but not emotionally or socially better, 1 month after surgery, according to a prospective longitudinal cohort study.
In pre- and post-op surveys, patients reported 1 average point lower on a 1-6 pain scale (from 3 to 2, P=0.04) after surgery compared with 2 weeks before surgery, and the proportion of patients reporting “good to excellent” physical health increased from 59% to 77.8% (P=0.03), reported Stefan Holubar, MD, MS, of the Cleveland Clinic, during the Crohn’s & Colitis Congress.
In addition, 83% reported having “good to excellent” overall health 30 days after surgery compared with 67% reporting as such 2 weeks pre-op (P=0.04).
Meanwhile, patient-reported social and emotional outcomes rated as “good to excellent” were similar before and after surgery for quality of life (74% and 83%, P=0.27), mental health (74% and 70%, P=0.68), social satisfaction (65% and 69%, P=0.70), and ability to perform socially (61% and 65%, P=0.65).
The difference in those reporting emotional problems “sometimes to always” within the past 7 days was also non-significant before surgery (70%) and after surgery (54%, P=0.07). Similarly, the difference in patients who reported feeling upset “most to all of the time” before (19%) and after (10%) surgery was not significant (P=0.15).
“Our data suggest patients are still recovering 30 days after surgery, and longer follow-up may reveal further improvements,” the authors noted in their poster. “Targeted psychosocial interventions and support at home early in the acute post-operative period may improve the quality of recovery after surgery for IBD patients.”
Elisa Boden, MD, of Oregon Health & Science University in Portland, who attended the conference but was not involved in this research, said this study is particularly useful because it’s a prospective longitudinal study from multiple sites on a topic for which high-quality data have been lacking.
She noted that it was “surprising” that patients “don’t feel like [improvements in pain and health] improve their quality of life, their mental health, and their emotional and social problems,” Boden added. She said that may change as the researchers look at longer periods after surgery.
“It would be interesting to see 6 months down the road or 3 months down the road where people are because if it doesn’t change those things, that’s also important for us to know,” she said. That may mean that surgery “addresses some pieces of [their IBD problems], but it might not address the mental health and emotional stress of living with a chronic disease.”
Like the researchers, Boden said the findings suggest greater social and emotional support may be helpful in the immediate post-op period. “Especially as people are going through surgery,” it may be necessary to help patients understand reasonable “expectations about what this is going to fix [and] what it’s not going to fix, or think about involving a health psychologist in this transition.”
Although statistically significant improvements occurred post-op in pain, overall health, and physical health, improvement in fatigue was marginally significant, and patients reported more difficulties with activities of daily living.
Changes in fatigue, while borderline significant (P=0.05), included reports of “moderate to very severe” fatigue falling from 71% pre-op to 54% post-op, and “none or mild” fatigue increasing from 29% pre-op to 46% post-op.
Several physical symptoms improved post-op while others remained stagnant, based on responses to the Crohn’s & Ulcerative Colitis Questionnaire. Patients reported an average 5 days of feeling unwell before surgery and an average 3 days of feeling unwell after surgery (P=0.02). They also post-operatively reported fewer days feeling bloated (5 to 2, P=0.04) and needing to rush to the toilet (5 to 1, P=0.0007). There was no significant change in the number of days they felt tired or felt abdominal pain, or in the number of nights they moved their bowels. Also, both before and after surgery, one in four respondents reported their bowels prevented socializing.
The only negative change with significance was the ability to perform activities of daily living, which 83% before and 63% after surgery reported as “good to excellent” (P=0.01).
For this study, Holubar and team analyzed data from the first 103 patients enrolled in the Crohn’s & Colitis Foundation’s IBD Plexus, a prospective longitudinal multicenter surgical cohort. Enrollment for adults undergoing major gastrointestinal surgery for an established IBD diagnosis began in August 2022 at six centers with 17 enrolling surgeons.
The analysis included responses from patients on the PROMIS General Health measures; the PROMIS Pain, Fatigue, and Sleep scales; and the Crohn’s & Ulcerative Colitis Questionnaire.
The patients had a median age of 43, 49% were women, and most had Crohn’s disease (64%), while 35% had ulcerative colitis and 1% had unspecified IBD. Preoperative surveys were completed by 67% of patients, and 56% completed post-op surveys.
Disclosures
The study was funded by the Crohn’s & Colitis Foundation.
Holubar reported consulting for Takeda.
Boden had no disclosures.
Primary Source
Crohn’s & Colitis Congress
Source Reference: Holubar S, et al “Does surgery for IBD deliver on its PROMIS-es? Impact of surgery on short-term patient-reported outcomes” CCC 2024; Poster 028.
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