Clinical-alimentary tractIrritable bowel syndrome and surgery: A multivariable analysis☆
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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2020, The LancetCitation Excerpt :In one survey, 51 (23%) of 223 patients with functional dyspepsia reported having surgery specifically to investigate their symptoms, including exploratory operations.77 A multivariate analysis examining the prevalence of surgery in patients with IBS, adjusting for multiple confounders, showed that having IBS was independently associated with three times higher prevalence of cholecystectomy, two times higher prevalence of appendicectomy and hysterectomy, and 50% higher prevalence of back surgery, compared with people without IBS.78 Such procedures, coupled with the fact that two-thirds of patients have seen a doctor in the preceding 12 months and 40% of patients are taking medication for their symptoms,4 add to the considerable health-care costs of managing FGIDs.77,79–81
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Supported by a grant from Novartis Pharmaceuticals Corp.