Searched for: person:fayea02
in-biosketch:true
Preoperative Risk Factors for Adverse Events in Adults Undergoing Bowel Resection for Inflammatory Bowel Disease: 15-Year Assessment of ACS-NSQIP
Fernandez, Cristina; Gajic, Zoran; Esen, Eren; Remzi, Feza; Hudesman, David; Adhikari, Samrachana; McAdams-DeMarco, Mara; Segev, Dorry L; Chodosh, Joshua; Dodson, John; Shaukat, Aasma; Faye, Adam S
IntroductionOlder adults with IBD are at higher risk for postoperative complications as compared to their younger counterparts, however factors contributing to this are unknown. We assessed risk factors associated with adverse IBD-related surgical outcomes, evaluated trends in emergency surgery, and explored differential risks by age.MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified adults ≥18 years of age who underwent an IBD-related intestinal resection from 2005-2019. Our primary outcome included a 30-day composite of mortality, readmission, reoperation, and/or major postoperative complication.ResultsOverall, 49,746 intestinal resections were performed with 9,390 (18.8%) occurring among older adults with IBD. Nearly 37% of older adults experienced an adverse outcome as compared to 28.1% among younger adults with IBD (p<0.01). Among all adults with IBD, the presence of preoperative sepsis (aOR, 2.08; 95%CI 1.94-2.24), malnutrition (aOR, 1.22; 95%CI 1.14-1.31), dependent functional status (aOR, 6.92; 95%CI 4.36-11.57), and requiring emergency surgery (aOR, 1.50; 95%CI 1.38-1.64) increased the odds of an adverse postoperative outcome, with similar results observed when stratifying by age. Further, 8.8% of surgeries among older adults were emergent, with no change observed over time (p=0.16).DiscussionPreoperative factors contributing to the risk of an adverse surgical outcome are similar between younger and older individuals with IBD, and include elements such as malnutrition and functional status. Incorporating these measures into surgical decision-making can reduce surgical delays in older individuals at low-risk and help target interventions in those at high risk, transforming care for thousands of older adults with IBD.
PMID: 37410929
ISSN: 1572-0241
CID: 5539322
Managing the older adult with inflammatory bowel disease: is age just a number?
Bermudez, Helen; Faye, Adam S; Kochar, Bharati
PURPOSE OF REVIEW:This review summarizes the most recent literature on older adults with inflammatory bowel diseases (IBD). Additionally, we review geriatric syndromes that may be pertinent to the management of older adults with IBD. RECENT FINDINGS:Traditionally chronological age has been used to risk stratify older adults with IBD, however physiologic status, including comorbidities, frailty, and sarcopenia, are more closely associated with clinical outcomes for older adults. Delaying care for and undertreating older adults with IBD based upon advanced chronologic age alone is associated with worse outcomes, including increased mortality. Treatment decisions should be made considering physiologic status, with an understanding of the differential risks associated with both ongoing disease and treatment. As such, there is an increasing recognition of the impact geriatric syndromes have on older adults with IBD, which need to be further explored. SUMMARY:Older adults with IBD are less likely to receive advanced therapies and timely surgery. They are also more likely to have adverse outcomes despite having similar disease courses to younger adults with IBD. Focusing on biological age as opposed to chronological age can shift this trajectory and improve quality of care for this growing population of patients with IBD.
PMCID:10275506
PMID: 37265181
ISSN: 1531-7056
CID: 5540902
Colorectal Cancer Screening and Surveillance in the Geriatric Population
Cheong, Janice; Faye, Adam; Shaukat, Aasma
PURPOSE OF THE REVIEW/OBJECTIVE:Our national guidelines regarding screening and surveillance for colorectal cancer recommend individualized discussions with patients 75-85 years of age. This review explores the complex decision-making that surrounds these discussions. RECENT FINDINGS/RESULTS:Despite updated guidelines for colorectal cancer screening and surveillance, the guidance for patients 75 years of age or older remains unchanged. Studies exploring the risks to colonoscopy in this population, patient preferences, life expectancy calculators and additional studies in the subpopulation of inflammatory bowel disease patients provide points of consideration to aid in individualized discussions. The benefit-risk discussion for colorectal cancer screening in patients over 75 years old warrants further guidance to develop best practice. To craft more comprehensive recommendations, additional research with inclusion of such patients is needed.
PMCID:10330554
PMID: 37219764
ISSN: 1534-312x
CID: 5536572
Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study
Faye, Adam S; Allin, Kristine Højgaard; Iversen, Aske T; Agrawal, Manasi; Faith, Jeremiah; Colombel, Jean-Frederic; Jess, Tine
BACKGROUND:There is an increasing incidence of inflammatory bowel disease (IBD) for which environmental factors are suspected. Antibiotics have been associated with development of IBD in earlier generations, but their influence on IBD risk in adults is uncertain. OBJECTIVE:To assess the impact of antibiotic exposure, including dose-response, timing and antibiotic class, on the risk of IBD in all individuals aged ≥10 years. DESIGN:Using Denmark nationwide registries, a population-based cohort of residents aged ≥10 years was established between 2000 and 2018. Incidence rate ratios (IRRs) for IBD following antibiotic exposure were calculated using Poisson regression. RESULTS:There were a total of 6 104 245 individuals, resulting in 87 112 328 person-years of follow-up, and 52 898 new cases of IBD. Antibiotic exposure was associated with an increased risk of IBD as compared with no antibiotic exposure for all age groups, although was greatest among individuals aged 40-60 years and ≥60 years (age 10-40 years, IRR 1.28, 95% CI 1.25 to 1.32; age 40-60 years, IRR 1.48, 95% CI 1.43 to 1.54; age ≥60 years, IRR 1.47, 95% CI 1.42 to 1.53). For all age groups a positive dose-response was observed, with similar results seen for both ulcerative colitis and Crohn's disease. The highest risk of developing IBD was seen 1-2 years after antibiotic exposure, and after use of antibiotic classes often prescribed to treat gastrointestinal pathogens. CONCLUSION:Antibiotic exposure is associated with an increased risk of IBD, and was highest among individuals aged 40 years and older. This risk increased with cumulative antibiotic exposure, with antibiotics targeting gastrointestinal pathogens and within 1-2 years after antibiotic exposure.
PMCID:9998355
PMID: 36623926
ISSN: 1468-3288
CID: 5447862
Antibiotic use and inflammatory bowel disease: number needed to harm? Authors' reply [Letter]
Faye, Adam S; Jess, Tine
PMID: 37226847
ISSN: 1468-3288
CID: 5543812
Antibiotic use and inflammatory bowel disease: Number needed to harm? Authors' reply
Faye, Adam S.; Jess, Tine
SCOPUS:85152288233
ISSN: 0017-5749
CID: 5460942
Risk factors for incomplete telehealth appointments among patients with inflammatory bowel disease
Stone, Katherine L.; Kulekofsky, Emma; Hudesman, David; Kozloff, Samuel; Remzi, Feza; Axelrad, Jordan E.; Katz, Seymour; Hong, Simon J.; Holmer, Ariela; McAdams-DeMarco, Mara A.; Segev, Dorry L.; Dodson, John; Shaukat, Aasma; Faye, Adam S.
Background: The COVID-19 pandemic led to the urgent implementation of telehealth visits in inflammatory bowel disease (IBD) care; however, data assessing feasibility remain limited. Objectives: We looked to determine the completion rate of telehealth appointments for adults with IBD, as well as to evaluate demographic, clinical, and social predictors of incomplete appointments. Design: We conducted a retrospective analysis of all patients with IBD who had at least one scheduled telehealth visit at the NYU IBD Center between 1 March 2020 and 31 August 2021, with only the first scheduled telehealth appointment considered. Methods: Medical records were parsed for relevant covariables, and multivariable logistic regression was used to estimate the adjusted association between demographic factors and an incomplete telehealth appointment. Results: From 1 March 2020 to 31 August 2021, there were 2508 patients with IBD who had at least one telehealth appointment, with 1088 (43%) having Crohn"™s disease (CD), 1037 (41%) having ulcerative colitis (UC), and 383 (15%) having indeterminate colitis. Of the initial telehealth visits, 519 (21%) were not completed, including 435 (20%) among patients <60 years as compared to 84 (23%) among patients ⩾60 years (p = 0.22). After adjustment, patients with CD had higher odds of an incomplete appointment as compared to patients with UC [adjusted odds ratio (adjOR): 1.37, 95% confidence interval (CI): 1.10"“1.69], as did females (adjOR: 1.26, 95% CI: 1.04"“1.54), and patients who had a non-first-degree relative listed as an emergency contact (adjOR: 1.69, 95% CI: 1.16"“2.44). While age ⩾60 years was not associated with appointment completion status, we did find that age >80 years was an independent predictor of missed telehealth appointments (adjOR: 2.92, 95% CI: 1.12"“7.63) when compared to individuals aged 60"“70 years. Conclusion: Patients with CD, females, and those with less social support were at higher risk for missed telehealth appointments, as were adults >80 years. Engaging older adults via telehealth, particularly those aged 60"“80 years, may therefore provide an additional venue to complement in-person care.
SCOPUS:85153736209
ISSN: 1756-283x
CID: 5499542
Risk factors for incomplete telehealth appointments among patients with inflammatory bowel disease
Stone, Katherine L; Kulekofsky, Emma; Hudesman, David; Kozloff, Samuel; Remzi, Feza; Axelrad, Jordan E; Katz, Seymour; Hong, Simon J; Holmer, Ariela; McAdams-DeMarco, Mara A; Segev, Dorry L; Dodson, John; Shaukat, Aasma; Faye, Adam S
BACKGROUND/UNASSIGNED:The COVID-19 pandemic led to the urgent implementation of telehealth visits in inflammatory bowel disease (IBD) care; however, data assessing feasibility remain limited. OBJECTIVES/UNASSIGNED:We looked to determine the completion rate of telehealth appointments for adults with IBD, as well as to evaluate demographic, clinical, and social predictors of incomplete appointments. DESIGN/UNASSIGNED:We conducted a retrospective analysis of all patients with IBD who had at least one scheduled telehealth visit at the NYU IBD Center between 1 March 2020 and 31 August 2021, with only the first scheduled telehealth appointment considered. METHODS/UNASSIGNED:Medical records were parsed for relevant covariables, and multivariable logistic regression was used to estimate the adjusted association between demographic factors and an incomplete telehealth appointment. RESULTS/UNASSIGNED: = 0.22). After adjustment, patients with CD had higher odds of an incomplete appointment as compared to patients with UC [adjusted odds ratio (adjOR): 1.37, 95% confidence interval (CI): 1.10-1.69], as did females (adjOR: 1.26, 95% CI: 1.04-1.54), and patients who had a non-first-degree relative listed as an emergency contact (adjOR: 1.69, 95% CI: 1.16-2.44). While age ⩾60 years was not associated with appointment completion status, we did find that age >80 years was an independent predictor of missed telehealth appointments (adjOR: 2.92, 95% CI: 1.12-7.63) when compared to individuals aged 60-70 years. CONCLUSION/UNASSIGNED:telehealth, particularly those aged 60-80 years, may therefore provide an additional venue to complement in-person care.
PMCID:10134163
PMID: 37124374
ISSN: 1756-283x
CID: 5544752
Sarcopenia as a Risk Prediction Tool in Inflammatory Bowel Disease [Comment]
Faye, Adam S; Dodson, John A; Shaukat, Aasma
PMID: 35366304
ISSN: 1536-4844
CID: 5206122
Perioperative Management of Ulcerative Colitis: A Systematic Review
Lee, Kate E; Faye, Adam S; Vermeire, Séverine; Shen, Bo
BACKGROUND:Patients with ulcerative colitis may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. Managing ulcerative colitis is complicated as there are many factors at play, including patient optimization and treatment; the guidance varies on the ideal perioperative use of corticosteroids, immunomodulators, biologics, and small molecule agents. OBJECTIVE:A systematic literature review was performed to describe the current status of perioperative management of ulcerative colitis. DATA SOURCES/METHODS:PubMed and Cochrane databases were used. STUDY SELECTION/METHODS:Studies between January 2000 and January 2022, in any language, were included. Articles regarding pediatric or endoscopic management were excluded. INTERVENTIONS/METHODS:Perioperative management of ulcerative colitis was included. MAIN OUTCOME MEASURES/METHODS:Successful management, including reducing surgical complication rates, was measured. RESULTS:A total of 121 studies were included in this review, including 23 meta-analyses or systematic reviews, 25 reviews, and 51 cohort studies. LIMITATIONS/CONCLUSIONS:Qualitative review including all study types. The varied nature of study types precludes quantitative comparison. CONCLUSION/CONCLUSIONS:Indications for colectomy in UC include severe disease unresponsive to medical treatment and colitis-associated neoplasia. Urgent colectomy has a higher mortality rate than elective colectomy. Corticosteroids are associated with postsurgical infectious complications and should be stopped or weaned before surgery. Biologics are not associated with adverse postoperative effects and do not necessarily need to be stopped preoperatively. Additionally, the clinician must assess individuals' comorbidities, nutrition status, and risk of venous thromboembolism. Nutritional imbalance should be corrected, ideally at preoperative period. Postoperatively, corticosteroids can be tapered based on the length of preoperative corticosteroid use.
PMID: 36007165
ISSN: 1530-0358
CID: 5338442