BMJ  2007;335:1109-1110 (1 December), doi:10.1136/bmj.39409.417188.BE

Letters

Colectomy and IBD

Does surgery improve survival?

The first 150 words of the full text of this article appear below.

The study by Roberts et al of mortality among patients in hospital for inflammatory bowel disease (IBD) has several limitations.1

Firstly, the observation that patients with IBD undergoing elective colectomy had lower mortality than those treated medically or needing emergency colectomy is not "strong evidence suggesting that the threshold for elective colectomy is too high." Patients who electively undergo colectomy usually have chronic relapsing disease or risk of malignancy, whereas those admitted to hospital for medical management or emergency colectomy are usually far sicker with severe acute or fulminant disease.2 These subgroups of patients have entirely different indications for colectomy, so lowering the threshold for elective surgery would not necessarily reduce numbers being admitted with severe acute disease.

Secondly, the authors' method of risk adjustment for comorbidity is flawed given the poor accuracy and completeness of secondary medical diagnostic coding in the hospital episode statistics database.3 Furthermore, their risk model . . . [Full text of this article]

Muhammad F Dawwas, specialist registrar

Addenbrooke's Hospital, Cambridge CB2 2QQ

drdawwas@gmail.com


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies
Stephen E Roberts, John G Williams, David Yeates, and Michael J Goldacre
BMJ 2007 335: 1033. [Abstract] [Full Text] [PDF]

Access jobs at BMJ Careers
Whats new online at Student BMJ