Irritable bowel syndrome and surgery: a multivariable analysis

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 > 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.