Sex-Based Differences in IBD Surgical Outcomes

Background: Although there are discrepancies in the development and progression of IBD based on biologic sex, little is known about differences in postoperative outcomes between men and women undergoing surgery for this condition. Objective: To compare rates of anastomotic leaks, wound complications, and serious adverse events between men and women undergoing surgery for IBD. Design: This was a retrospective cohort study. Settings: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program IBD Collaborative database, which includes 15 high-volume IBD surgery centers. Patients: All adult patients undergoing surgery for IBD were included. Participants with missing data for exposure or outcome variables were excluded. Main outcome measures: Rates of anastomotic leaks, wound complications, and serious adverse events were compared between women and men. Results: A total of 3143 patients were included. There was a significant association between sex and BMI, IBD type, and preoperative medication use. Women had decreased odds of serious adverse events compared to men (OR 0.73; 95% CI, 0.55-0.96), but there was no significant association between sex and anastomotic leaks or wound complications. IBD type was found to be an effect measure modifier of the relationship between sex and serious adverse events. Among patients with ulcerative colitis, women had a 54% decrease in the odds of serious adverse events compared to men, whereas there was no significant difference between women and men with Crohn's disease. Limitations: This study was limited by capturing only 30 days of postoperative outcomes. Conclusions: Women undergoing surgery for ulcerative colitis had decreased odds of serious adverse events compared to men. Understanding sex-based differences in outcomes allows clinicians to make patient-centered decisions regarding surgical planning and perioperative management for patients with IBD. See Video Abstract .