The impact of Hispanic ethnicity and race on post-surgical complications in patients with inflammatory bowel disease.

BACKGROUND: Surgery for inflammatory bowel disease (IBD) is common and represents a large portion of the cost of IBD treatment. There are multiple risk factors for post-operative complications after IBD surgery, but the role of ethnicity remains unclear. The aim of our study was to compare the rate of post-operative complications in Hispanic and non-Hispanic patients with equal access to health care. METHODS: We designed a case-control study including patients enrolled in a health plan available to uninsured patients at Jackson Memorial Hospital (Miami, FL, USA) who had access to health care for at least 24 consecutive months prior to surgery. Sixty-seven Hispanic patients (cases) and 75 non-Hispanic patients (controls) met criteria and were compared with respect to demographics, type of surgery, disease phenotype, and laboratory markers. Primary outcome was the development of a medical or surgical complication. RESULTS: A slight numerical increase in post-operative complications was seen in Hispanic patients; this did not reach statistical significance [1.06 (95 % CI 0.48-2.36; p = 0.88)]. Factors independently associated with post-operative complications included diagnosis of ulcerative colitis [OR 5.4 (95 % CI 1.67-20.58; p = 0.004)], pre-operative albumin levels <3 mg/dL [OR: 8.2 (95 % CI 2.3-35.5; p < 0.001)], smoking [OR 15.7 (95 % CI 4.2-72.35; p < 0.001)], and use of ≥20 mg of prednisone [OR 6.7 (95 % CI 2.15-24.62; p < 0.001)]. CONCLUSIONS: In a group of patients with equal access to medical care and follow-up, Hispanics and non-Hispanics with IBD that underwent surgery had no significant differences in types of IBD surgeries or post-surgical outcomes.

The Role of Histology in Determining Disease Activity, Treatment, and Prognosis: Are We There yet?

Histologic activity in inflammatory bowel disease is associated with an increased risk of clinical relapse, surgery, hospitalizations, and disease-associated dysplasia independent of clinical or endoscopic activity. Several histologic scoring systems exist to capture disease activity. However, none has been validated to assess prognosis or response to therapy and there is no universally accepted definition of histologic healing or remission. Although histologic healing is not a current recommended target for treatment, it may be a more sensitive marker of disease activity. Future studies are needed to determine standardized definitions of disease activity, healing, and evaluating normalization of histology as clinical trial outcomes.