Estado de la cirugía de la enfermedad inflamatoria en España. Resultado de una encuesta nacional

Abstract

IntroductionThe incidence of inflammatory bowel disease (IBD) is increasing in Spain but there is little information on the availability of multidisciplinary care. This study aims to assess surgeon's opinions on the current situation of surgery for IBD in Spain. MethodsAn electronic closed survey was sent to members of the Spanish Association of Surgeons (AEC) from January to March 2015. This was a 52-item anonymised questionnaire with questions about how the treatment of IBD patients is organized in each centre, the existence of specific units, the management strategy in IBD patients, and the opinion of colorectal, general and trainee surgeons about the surgical treatment of IBD in their centre and in Spain. ResultsOne hundred and ninety-two surgeons responded. Most participants work in tertiary hospitals (45%), most of them from different hospitals, some from the same hospital. Only 50% of hospitals have multidisciplinary teams for IBD. The initial approach is laparoscopic in 56% of cases, and 80% of participants in centres with multidisciplinary teams consider the timing of surgery to be appropriate. The annual number of IBD surgeries in tertiary hospitals is higher than in secondary hospitals in ulcerative colitis (57 vs. 24% 10-15 patients/year, P<.001) and Crohn's disease (68 vs. 28% 3-5 patients/month, P<.001). Most centres operate less than 10 ulcerative colitis patients per year, even larger centres (67%) and they perform ≤3 J-pouches/month (ulcerative colitis and other indications) (P<.001). Ninety-five percent of surgeons consider that centralization of complex cases in specialized units and the creation of national registries should be developed. The majority of participants (70%) believe that there is a deficit in research and educational activities in IBD surgery in Spain. ConclusionThis survey suggests that most Spanish hospitals have a low volume of IBD surgery, even large tertiary hospitals, and many centres do not have a multidisciplinary team dedicated to IBD patients. Most survey participants believe it is necessary to develop registries and increase training and research in IBD surgery in Spain.