title: Postoperative Mortality Among Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis of Population-Based Studies.
abstract: OBJECTIVE
  There have been varying reports of mortality after intestinal resection for the inflammatory bowel diseases (IBDs). We performed a systematic review and meta-analysis of population-based studies to determine postoperative mortality after intestinal resection in patients with IBD.
  
  
  METHODS
  We searched Medline, EMBASE, and PubMed, from 1990 through 2015, to identify 18 articles and 3 abstracts reporting postoperative mortality among patients with IBD. The studies included 67,057 patients with ulcerative colitis (UC) and 75,971 patients with Crohn's disease (CD), from 15 countries. Mortality estimates stratified by emergent and elective surgeries were pooled separately for CD and UC using a random-effects model. To assess changes over time, the start year of the study was included as a continuous variable in a meta-regression model.
  
  
  RESULTS
  In patients with UC, postoperative mortality was significantly lower among patients who underwent elective (0.7%; 95% confidence interval [CI], 0.6%-0.9%) vs emergent surgery (5.3%; 95% CI, 3.8%-7.4%). In patients with CD, postoperative mortality was significantly lower among patients who underwent elective (0.6%; 95% CI, 0.2%-1.7%) vs emergent surgery (3.6%; 95% CI, 1.8%-6.9%). Postoperative mortality did not differ for elective (P = .78) or emergent (P = .31) surgeries when patients with UC were compared with patients with CD. Postoperative mortality decreased significantly over time for patients with CD (P < .05) but not UC (P = .21).
  
  
  CONCLUSIONS
  Based on a systematic review and meta-analysis, postoperative mortality was high after emergent, but not elective, intestinal resection in patients with UC or CD. Optimization of management strategies and more effective therapies are necessary to avoid emergent surgeries.
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sunny
authors.initials: S
authors.lastname: Singh
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Darmaki
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alexandra D
authors.initials: AD
authors.lastname: Frolkis
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Seow
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Leung
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Novak
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Bertus
authors.initials: B
authors.lastname: Eksteen
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.affiliation: Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada. Electronic address: ggkaplan@ucalgary.ca.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D003424:Crohn Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D017558:Elective Surgical Procedures; D004630:Emergencies; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complication; Death; Survival; Treatment