SP10.16 Impact of joint surgical and medical management on outcomes in inflammatory bowel disease. A retrospective review of medical management and surgical outcomes in a District General

Abstract

Abstract Aim A combined medical and surgical team approach for management of inflammatory bowel disease (IBD) facilitates optimized medical and surgical management through dedicated MDTs and clinics. These benefits were delivered during the COVID-19 pandemic impacting planned medical care. Method Data was collected for all IBD patients undergoing resection surgery over 16 years of age covering a 2-year period before and a 2-year period after the impact of COVID-19 pandemic and start of a combined IBD practice. It included demographics, immune-suppression and planned and unplanned surgery between January 2018 to September 2021. Results 62 patients underwent major resection surgery. Six were excluded for non-IBD related indication (malignancy, infective colitis and volvulus). Of the remaining 56 patients, 20 (35.7%) had Crohn’s Disease, 35 (62.5%) had Ulcerative colitis and one (1.8%) with indeterminate colitis on histopathology. The median age was 43.6 years (16 to 80) with 64.3% females. In the first 2-year period, 73.7% (14) underwent surgery with high perioperative immunosuppression. This reduced to 26.3% (5) in the combined IBD period. Proportion of patients undergoing emergency surgery declined from 59% to 12.5%. Use of biologics increased from 29% to 50% of patients with the average of 0.71 vs 2.13 failed biologics use before surgical intervention. Conclusion Combined medical and surgical IBD practice offers optimised care through timely escalation of medical treatment and reduces risks associated with major emergency surgery. Despite the restrictions to planned surgical treatment during the COVID-19 pandemic, improved outcomes were achieved with combined practice for IBD patients.