Irritable bowel syndrome and surgery: A multivariable analysis☆
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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 > or =3 years of records.Results Questionnaire/record agreement for IBS and surgery was 83.6% (kappa = 0.68) and 95.5%-100.0% (kappa = 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.
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Patients with IBS are at increased risk of iatrogenic harms, through unnecessary surgery, including hysterectomy, appendicectomy and cholecystectomy, and inappropriate prescribing of opioids.
“Furthermore, patients are at increased risk of iatrogenic harms, through unnecessary surgery, including hysterectomy, appendicectomy and cholecystectomy, 121 and inappropriate prescribing of opioids.90”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [121]
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- Authors
- Longstreth, G. F., & Yao, J. F.
- Affiliations
- Kaiser Permanente (US)
- Corresponding author
- Longstreth, George F.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2004-06
- Volume
- 126
- Issue
- 7
- Pages
- 1665-1673
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2130721753
- Cited by
- 248
- References
- 58
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 10 · 2023: 6 · 2022: 10 · 2021: 14 · 2020: 10 · 2019: 9 · 2018: 4 · 2017: 7 · 2016: 5 · 2015: 15 · 2014: 14 · 2013: 16 · 2012: 14
- FWCI
- 12.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- irritable bowel syndrome, surgical history, cholecystectomy, appendectomy, hysterectomy, back surgery, coronary artery bypass grafting, peptic ulcer surgery, risk factors, demographic factors, medical factors, questionnaire validity, questionnaire response bias
- MeSH terms
- Adult, Aged, Female, Health Maintenance Organizations, Humans, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, Digestive System Surgical Procedures, Cohort Studies, Multivariate Analysis, Irritable Bowel Syndrome
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