Sex-Based Differences in IBD Surgical Outcomes

Dis Colon Rectum. 2024 Feb 1;67(2):246-253. doi: 10.1097/DCR.0000000000002984.Epub 2023 Oct 23.


Margaret H Sundel 1John J Newland 1Kyle W Blackburn 1Roumen M Vesselinov 2Samuel Eisenstein 3Andrea C Bafford 1NSQIP-IBD Collaborative


NSQIP-IBD Collaborative: 

Samuel EisensteinSonia RamamoorthyNicholas HilbertAustin Du 4Tracy HullStefan HolubarXue JiaNancy AnzlovarSue Bohne 5Alessandro FicheraDebbie AguilarMartha Mueller 6Rocco RiccardiLiliana BordeianouHiroko KunitakeDonna AntonelliKathy SwierzewskiLynn Devaney 7Cindy KinDavid SpainRoxanne HykeElmer De LeonAimee Torbela 8Edward LeeBrian ValerianMegan KeenanAndrea Goyette 9Evangelos MessarisRichard WhyteMary WardMary Beth Cotter 10Julia SaraidaridisW David LewisMary SansoneLynne Crawford 11Michael DeutschJeffrey ScowPam Huggins 12Virginia ShafferJoe SharmaShamsah Sitafalwalla 13Radhika SmithMatthew MutchBruce HallMitzi HirbeJoAnn Batten 14Randolph SteinhagenSergey KhaitovPatricia SyllaCelia DivinoReba Miller 15Kinga Skowron OlorteguiNeil HymanVivek PrachandSue SullivanLorice PullinsCarmen Barc 16Jennifer HrabeMuneera KapadiaMary Belding-Schmitt 17James YooJoel GoldbergFelix AkinbamiJill Steinberg 1


Author information

1Department of Surgery, University of Maryland, Baltimore, Maryland.

2Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland.

3Department of Surgery, University of California San Diego, San Diego, California.

4Department of Colon & Rectal Surgery, Cleveland Clinic, 9500 Euclid Ave A30, Cleveland, OH 44195.

5Department of Surgery, Baylor University Medical Center, 3409 Worth St, Worth Tower, Suite 600, Dallas, TX 75246.

6Colorectal Surgery Program, Massachusetts General Hospital, 15 Parkman St, Boston, MA 02114-3117.

7Stanford Health Care, 500 Pasteur Dr, Palo Alto, CA 94304.

8Division of General Surgery, Albany Medical Center, 50 New Scotland Ave MC-193, 5th Floor, Albany, NY 12208.

9Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Shapiro Building, 3rd Floor, Boston, MA 02215-5400.

10Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA 01805.

11Department of Surgery, Penn State Health, 200 Campus Dr, Suite 3100 Hershey, PA 17033.

12Department of Surgery, Emory University School of Medicine, Room B206, 1364 Clifton Rd, NE, Atlanta, GA 30322.

13Department of Surgery, Washington University School of Medicine in St Louis, 660 S Euclid Ave, St Louis, MO 63110.

14Department of Surgery, Box 1259, Mount Sinai Medical Center, One Gustave L. Levy Place, NY, NY 10029.

15Department of Surgery, University of Chicago, 5841 S Maryland Ave, MC 5095, Chicago, IL 60637.

16Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242.

17Department of Surgery, University of Iowa, Iowa City, IA 52242.

18Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.


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 .

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