Gastroenterology

Gastroenterology

Volume 126, Issue 7, June 2004, Pages 1665-1673
Gastroenterology

Clinical-alimentary tract
Irritable bowel syndrome and surgery: A multivariable analysis

https://doi.org/10.1053/j.gastro.2004.02.020Get rights and content

Abstract

Background & Aims: Patients with irritable bowel syndrome (IBS) have high surgical rates. We investigated the demographic and medical factors independently associated with surgical histories of health examinees. Methods: We applied multiple stepwise logistic regression analysis to self-completed questionnaire data from 89,008 examinees, assessing 6 surgeries as outcomes. We assessed questionnaire/physician record agreement of physician-diagnosed IBS and surgical history on 201 randomly selected examinees with ≥3 years of records. Results: Questionnaire/record agreement for IBS and surgery was 83.6% (κ = 0.68) and 95.5%–100.0% (κ = 0.82–1), respectively. IBS was reported by 4587 examinees (5.2%) (1382 men [3.0%] and 3205 women [7.5%]). Subjects with and without IBS, respectively, reported the following surgical procedures: cholecystectomy, 569 (12.4%) versus 3428 (4.1%), P < 0.0001; appendectomy, 967 (21.1%) versus 9906 (11.7%), P < 0.0001; hysterectomy, 1063 (33.2%) versus 6751 (17.0%), P < 0.0001; back surgery, 201 (4.4%) versus 2436 (2.9%), P < 0.0001; coronary artery surgery, 127 (2.8%) versus 2033 (2.4%), P > 0.05; peptic ulcer surgery, 22 (0.5%) versus 277 (0.3%), P > 0.05. Among independent surgery associations, IBS was associated with cholecystectomy (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.89–2.31; P < 0.0001), appendectomy (OR, 1.45; 95% CI, 1.33–1.56; P < 0.0001), hysterectomy (OR, 1.70; 95% CI, 1.55–1.87; P < 0.0001), and back surgery (OR, 1.22; 95% CI, 1.05–1.43; P = 0.0084). Conclusions: Health examinees with physician-diagnosed IBS report rates of cholecystectomy 3-fold higher, appendectomy and hysterectomy 2-fold higher, and back surgery 50% higher than examinees without IBS; IBS is independently associated with these surgical procedures.

Section snippets

Patients and methods

We performed the study in the Kaiser Permanente Medical Care Plan, a group-model HMO with about 500,000 members in the San Diego area, in which most health care costs are prepaid. Members are encouraged to undergo a health screening evaluation at age-related intervals, and about one sixth of the adult members undergo the examination annually. The evaluation includes a sex-specific, self-completed history questionnaire in English or Spanish, screening laboratory/radiologic tests, and a physical

Results

During the 3 years analyzed, there were 178,165 examination questionnaires. We excluded 56,863 questionnaires from examinees with multiple examinations and 32,294 incomplete questionnaires, leaving 89,008 questionnaires (46,159 men and 42,849 women), representing 73.4% of all examinees. The overall age and proportion of women (mean ± SD) in the analyzed group versus the incomplete questionnaire group were 49.6 ± 15.5 years versus 54.2 ± 15.7 years (P < 0.0001) and 48.1% versus 68.2% (P <

Discussion

In this multiple stepwise logistic regression analysis of 89,008 medical questionnaires from HMO examinees, a diagnosis of IBS was independently associated with increased rates of cholecystectomy, appendectomy, hysterectomy, and back surgery. Notably, 3 times as many subjects with IBS reported undergoing cholecystectomy compared with individuals without IBS. For examinees with IBS, rates of appendectomy and hysterectomy were twice as high as for those without IBS and the rate of back surgery

Acknowledgements

The authors thank Girma Wolde-Tsadik, Ph.D., for statistical consultation.

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