THE PREDICTORS AND OUTCOME OF SURGERY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT THE UNIVERSITY HOSPITAL OF THE WEST INDIES, JAMAICA

Abstract BACKGROUND Inflammatory Bowel Disease (IBD) is a chronic idiopathic inflammatory condition of the bowel with 2 main disorders- Ulcerative Colitis (UC) and Crohn’s Disease (CD). Despite appropriate medical therapy some patients will require surgery. The aim of this study is to identify the frequency, predictors and outcome of surgery in patients with IBD at the University Hospital of West Indies (UHWI) from January 1, 2004 to July 31, 2024. METHODS This is a cross- sectional study of patients ≥ 16 years with IBD seen at the UHWI from January 1, 2004 to July 31, 2024 with IBD. Data was extracted from the patients’ medical records. The primary outcome variable was the need for IBD related surgery. Associations between the outcome of interest and explanatory variables were determined using logistic regression. RESULTS Data was analysed for 155 patients (64 with CD and 91 with UC). Forty- four patients (28.4%) had undergone at least one IBD related surgery, 36 (53.3%) had CD and 8 (8.8%) had UC. For those requiring surgery the mean age was 43.5 ± 14.1 years, 24 (54.6%) were females, mean age of IBD diagnosis was 27.1 ± 10.8 years, mean disease duration was 16.3 ± 11.2 years, and mean time to first surgery after diagnosis of IBD was 4.2 ± 6.8 years. Patients who had undergone at least one IBD related surgery were significantly younger at the time they were diagnosed with IBD (27.1 ± 10.8 years versus 36.3 ± 17.1 years; p = 0.001) and had disease for a longer duration of time (16.3 ± 11.2 years versus 12.3 ± 9.4 years; p = 0.025) compared to those who did not undergo surgery. For patients who had CD significantly more patients in the surgery group were diagnosed between ages 17- 40 years (29 [80.6%] versus 16 [57.1%]; p = 0.024), had ileocolonic disease extent (27 [75.0%] versus 12 [42.9%]; p = 0.025) and had penetrating disease behaviour (19 [54.3%] versus 8 [29.6%]; p = 0.028) compared to those who had no surgery. More patients with CD who had at minimum one IBD related surgery were treated with a biologic agent (15 [41.7%] versus 5 [17.9%]; p = 0.041). The most common indications for surgery were spontaneous perforation (11 [25.0%]), symptomatic fistula (7 [15.9%]) and bowel obstruction (6 [13.6%]). For those who had IBD related surgery the median duration of hospital stay was 8.5 days (IQR 4.5, 15.5), there were no deaths, and one patient (2.2%) developed a wound infection. In multivariate analyses disease duration (aOR 1.06; p = 0.006), CD (aOR 12.5; p < 0.001) and treatment with a biologic agent were significantly associated with a higher odds of undergoing an IBD related surgery. CONCLUSION Approximately 28% of Jamaican patients with IBD required surgery for their disease over a 10-year period. Early disease identification, risk stratification and early appropriate medical therapy are necessary to reduce the frequency of surgery and poor outcome.