Early referral does not mean early surgery in IBD
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ORLANDO — Surgeons have become an important part of an inflammatory bowel disease care team. While there were only a handful of surgeons who participated in meetings with patients, Feza H. Remzi, MD, of NYU Langone School of Medicine, said it is now much more common.
Remzi told Healio Gastroenterology and Liver Disease that having a surgeon as part of a care team should send a message of collaboration to the patient and not an indication that they are being rushed to surgery.
“Early referral to surgery doesn't mean early surgery,” he said. “Early referral to a surgeon means getting to know the surgeon on an elective atmosphere, talking about the pros and cons of what it will involve. That is such an important message because you don't want to see the surgeon at the time of emergency, that really is a very tough thing to come across as a patient.”
If they only see the surgeon just before surgery, Remzi said patients tend to lose trust. Instead of seeing surgical therapy as elective or semi-elective, they can feel like they are being rushed into it.
Additionally, collaboration with surgeons adds another voice to the discussion of weighing the role of medications before surgery, particularly biologics.
“This was a big discussion that has been going on in the last 10 years or so, and the opinion has been divided,” Remzi said. “Biologics alone in someone who is doing okay and needs surgery is not an issue. The concern about the biologics is patients being dragged on and the futile use of biologics.”
Remzi said there needs to be a discussion with patients and their care team about the role of biologics and the need and timing of surgery.
“We should be focusing on the fact that biologics are the number one treatment for inflammatory bowel disease, but prolonging the futile usage of biologics may have severe consequences that may impact outcomes,” he said, adding that collaboration is incredibly important for now and for the future. – by Alex Young
Disclosures: Remzi reports no relevant financial disclosures.