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Published on: September 20, 2018
Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review
Marie Strøm Zangenberg1, Alaa El-Hussuna2
1Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge 4600, Denmark.
Insights
Patients undergoing surgery for inflammatory bowel disease (IBD) face an increased risk of depression and anxiety. Factors like comorbidities and gender influence these risks, necessitating further high-quality research.
Area of Science:
- Gastroenterology and Psychiatry
- Surgical Outcomes Research
Background:
- Inflammatory bowel disease (IBD) significantly impacts patients' quality of life.
- Surgery is a common treatment modality for IBD, but its psychological sequelae are not fully understood.
Purpose of the Study:
- To systematically review and synthesize evidence on psychiatric morbidity following IBD-related surgery.
- To identify specific psychiatric disorders and risk factors associated with IBD surgery.
Main Methods:
- Adherence to PRISMA guidelines and a published protocol (PROSPERO CRD42016037600).
- Inclusion of studies reporting on IBD patients undergoing surgery and their risk of psychiatric disorders.
- Systematic review of 12 non-randomized studies involving 4340 patients, assessing risk of bias.
Main Results:
- IBD surgery patients showed higher depression risk versus diverticulitis or hernia surgery patients, but not cancer surgery patients.
- Crohn's disease patients had increased depression risk post-surgery compared to non-surgical counterparts.
- Ulcerative colitis patients exhibited higher anxiety risk post-surgery compared to colorectal cancer surgery patients.
- High comorbidity scores (Charlson >3) and female gender independently predicted depression and anxiety.
Conclusions:
- Evidence suggests increased depression risk for Crohn's disease patients and anxiety risk for ulcerative colitis patients post-surgery.
- The overall risk of psychiatric morbidity after IBD surgery requires further investigation with high-quality, low-bias studies.
- Comorbidities and gender are significant predictors requiring clinical consideration in IBD surgical patients.
Aim:
To examine the evidence about psychiatric morbidity after inflammatory bowel disease (IBD)-related surgery.
Methods:
PRISMA guidelines were followed and a protocol was published at PROSPERO (CRD42016037600). Inclusion criteria were studies describing patients with inflammatory bowel disease undergoing surgery and their risk of developing psychiatric disorder.
Results:
Twelve studies (including 4340 patients) were eligible. All studies were non-randomized and most had high risk of bias. Patients operated for inflammatory bowel disease had an increased risk of developing depression, compared with surgical patients with diverticulitis or inguinal hernia, but not cancer. In addition, patients with Crohn's disease had higher risk of depression after surgery compared with non-surgical patients. Patients with ulcerative colitis had higher risk of anxiety after surgery compared with surgical colorectal cancer patients. Charlson comorbidity score more than three and female gender were independent predictors for depression and anxiety following surgery.
Conclusion:
The review cannot give any clear answer to the risks of psychiatric morbidity after surgery for IBD studies with the lowest risk of bias indicated an increased risk of depression among surgical patients with Crohn's disease and increased risk of anxiety among patients with ulcerative colitis.
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