Preoperative performance status was associated with postoperative fatal complications in elderly patients with refractory ulcerative colitis

doi:10.4240/wjgs.v17.i8.109326

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Aug 27, 2025; 17(8): 109326
Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.109326

Table 1 Postoperative complications

Parameters	All patients, n = 191	CDC grade 1	CDC grade 2	CDC grade 3	CDC grade 4	CDC grade 5
All complications¹	118 (61.7)	7 (3.6)	71 (37.1)	22 (11.5)	4 (2.0)	14 (7.3)
Infectious complications
Incisional SSI	27 (14.1)	8 (4.1)	13 (6.8)	6 (3.1)	0	0
Organ/space SSI	19 (9.9)	0	7 (3.6)	10 (5.2)	1 (0.5)	1 (0.5)
Bloodstream infections	7 (3.6)	0	6 (3.1)	0	0	1 (0.5)
Pneumonia	19 (9.9)	0	7 (3.6)	0	4 (2.0)	8 (4.1)
Other infections²	7 (3.6)	0	6 (3.1)	0	1 (0.5)	0
Other complications
Obstruction/ileus	21 (10.9)	0	14 (7.3)	7 (3.6)	0	0
Postoperative bleeding	24 (12.5)	1 (0.5)	11 (5.7)	6 (3.1)	2 (1.0)	4 (2.0)
Thrombosis	16 (8.3)	0	16 (8.3)	0	0	0
Urinary retention	0	0	0	0	0	0
High-output stoma	7 (3.6)	0	7 (3.6)	0	0	0

¹The highest grade of complications for each patient.

²Other infections included urinary tract infection and fever (> 38 °C) of other or unknown origins.

Data are presented as n (%) in parentheses unless otherwise indicated. CDC: Clavien-Dindo classification; SSI: Surgical site infection.

Table 2 Patient characteristics

	All elderly patients, n = 191	Fatal complication group¹, n = 18	Non-fatal complication group, n = 173	P value
Sex, male/female	131/60	15/3	116/57	0.15
Age at surgery (years)	70.8 ± 7.5	73.7 ± 8.4	70.5 ± 7.3	0.09
Elderly onset	139 (72.7)	16 (88.8)	123 (71.0)	0.10
Disease duration (months)	28 (6-103)	9 (3.75-64)	30 (7-104)	0.48
Severe disease	103 (53.9)	14 (77.7)	89 (51.4)	0.04^b
Alb (g/dL)	2.6 (2.1-3.2)	2.2 (1.7-2.7)	2.6 (2.1-3.2)	0.15
Lymphocyte (count/μL)	1114 (543-1668)	688 (204-1544)	1164 (564-1684)	0.06
CRP (mg/dL)	1.7 (0.2-5.7)	3.3 (0.7-8.5)	1.5 (0.2-5.5)	0.11
BMI	18.8 (16.6-21.4)	16.8 (15.0-19.5)	18.8 (17.0-21.4)	0.02^b
Performance status ≥ 3	46 (24.0)	14 (77.7)	32 (18.4)	< 0.01^b
Smoker	32 (16.7)	1 (5.5)	31 (17.9)	0.18
ASA-PS ≥ 3	90 (47.1)	13 (72.2)	77 (44.5)	0.06
Carlson risk index ≥ 3	18 (9.4)	4 (22.2)	14 (8.0)	0.05
Pharmacotherapy
Total given PSL dose (mg)	2000 (500-6260)	1840 (1176-5150)	2000 (500-6610)	0.55
Preoperative PSL	102 (53.4)	13 (72.2)	89 (51.4)	0.09
Immunomodulators	89 (46.5)	4 (22.2)	85 (49.1)	0.02^b
Calcineurin inhibitors	18 (9.4)	2 (11.1)	16 (9.2)	0.16
JAK inhibitors	3 (1.5)	0 (0)	3 (1.7)	0.57
Biologics	60 (31.4)	5 (27.7)	55 (31.7)	0.72
Urgent/emergent surgery	90 (47.1)	15 (83.3)	75 (43.3)	< 0.01^b
Laparoscopic surgery	47 (24.6)	4 (22.2)	43 (24.8)	0.80
Operative time (minutes)	202 (163-253)	173 (122-193)	207 (172-262)	< 0.01^b
TC with ileostomy	96 (50.2)	12 (66.6)	84 (48.5)	0.14
APR with ileostomy	47 (24.6)	1 (5.5)	46 (26.5)	0.04^b
Pouch surgery	58 (30.3)	3 (16.6)	55 (31.7)	0.18
Blood loss (mL)	170 (75-300)	100 (27-196)	180 (80-310)	0.73
Blood transfusion	90 (47.1)	10 (55.5)	80 (46.2)	0.45

¹Fatal complications include life-threatening complications requiring intensive care unit management and the death of a patient.

^bP < 0.05 (significantly different).

Data are presented as numbers with percentages in parentheses unless otherwise indicated. Continuous variables are indicated as the mean ± SD and median (quartile range). UC: Ulcerative colitis; PSL: Prednisolone; CRP: C reactive protein; Alb: Albumin; BMI: Body mass index; ASA: American Society of Anesthesiologists; TC: Total colectomy; APR: Abdominal perineal resection.

Table 3 Logistic regression analysis of risk factors for fatal complications¹

Factors	Univariate analysis		Multivariate analysis
Factors	OR (95%CI)	P value	OR (95%CI)	P value
Age at surgery (1-year intervals)	1.05 (0.99-1.12)	0.09	1.01 (0.93-1.10)	0.76
Severe disease	3.30 (1.04-10.43)	0.04^b	1.10 (0.22-5.34)	0.90
BMI < 17	3.11 (1.16-8.37)	0.01^b	4.08 (1.19-13.97)	0.02^b
Preoperative PSL	2.45 (0.83-7.18)	0.09	3.67 (0.92-14.60)	0.05
Immunomodulators	0.29 (0.09-0.93)	0.02^b	0.41 (0.10-1.60)	0.18
Urgent/emergent surgery	6.53 (1.82-23.39)	< 0.01^b	1.61 (0.28-9.15)	0.58
Performance status ≥ 3	15.42 (4.75-49.96)	< 0.01^b	14.5 (3.43-61.64)	< 0.01^b
Lymphocyte count (1/μL intervals)	0.99 (0.99-1.00)	0.04^b	1.00 (0.99-1.00)	0.56
Carlson risk index ≥ 3	3.22 (0.93-11.12)	0.05	1.74 (0.37-8.17)	0.48

¹Fatal complications include life-threatening complications requiring ICU management and the death of a patient.

^bP < 0.05 (significant difference).

OR: Odds ratio; 95%CI: 95% confidence interval; Alb: Albumin; ASA: American Society of Anesthesiologists; BMI: Body mass index; PSL: Prednisolone.

Citation: Horio Y, Uchino M, Tomoo Y, Nomura K, Nagano K, Kusunoki K, Kuwahara R, Kimura K, Sato T, Kataoka K, Igeta M, Shinzaki S, Ikeda M, Ikeuchi H. Preoperative performance status was associated with postoperative fatal complications in elderly patients with refractory ulcerative colitis. World J Gastrointest Surg 2025; 17(8): 109326
URL: https://www.wjgnet.com/1948-9366/full/v17/i8/109326.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i8.109326