Short-term psychiatric outcomes after ostomy vs nonostomy surgery in biologic-treated IBD patients

Patients with inflammatory bowel disease (IBD) who undergo multiple surgeries or stoma creation experience higher rates of anxiety and depression compared with patients with who have not undergone surgery. However, there are limited comparative data on short-term psychiatric outcomes in patients with IBD undergoing stoma-related IBD surgery vs nonstoma IBD surgery, specifically in patients treated with biologics.

We conducted a population-based cohort study using TriNetX, of adults 18 to 65 years of age with newly diagnosed IBD between January 1, 2016, and December 31, 2019. Eligible patients had received biologic therapy and had no prior IBD-related surgeries or psychiatric diagnoses. Two cohorts were defined: (1) patients who underwent IBD-related surgery resulting in colostomy or ileostomy creation and (2) patients who underwent IBD-related surgery without ostomy creation. Incidence of depression, anxiety, and adjustment disorders was assessed using International Classification of Diseases-Tenth Revision codes from postoperative day 1 up to 6 months postsurgery. Variables were propensity score matched for the two cohorts.

A total of 1636 biologic-treated patients with IBD were included (818 per cohort). Comparing ostomy patients with nonostomy patients, depression occurred in 11.37% vs 6.24% (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.35-2.76), anxiety occurred in 15.53% vs 11.98% (OR, 1.35; 95% CI, 1.02-1.79), and adjustment disorders occurred in 4.4% vs 2.57% (OR, 1.75; 95% CI, 1.01-3.02).

Overall, ostomy creation was associated with greater short-term psychiatric morbidity in patients with IBD treated with biologics. Future research should explore specific factors that make this group of patients more vulnerable to anxiety and depression and aim to develop targeted mental health interventions.