Introduction Consideration of emergency colectomy in IBD is a common clinical situation in acute disease episodes facing gastroenterologists and surgeons. This study aimed to describe changes in incidence and outcomes in the last 14 years.
Method Trust information departments at Newcastle upon Tyne and Gateshead Health foundation trusts were contacted to request data for all emergency admissions under a general surgeon from 2000–2014 after necessary approvals. Emergency colectomies for IBD were identified using ICD-10 codes K50 and K51; and OPCS-4 procedure codes H04–11, H29 and H33. Data on demographics, co-morbidities, interventions and outcomes were also collected and analysed.
Results There were 208 emergency colectomies for IBD from a total of 1,275 emergency colectomies (16.4%); 130 for Crohn’s and 78 for UC. The mean age was 43.2 years (95% CI: 40.6 to 45.8 years), 52.4% of patients were men. Patients with Crohn’s were younger at resection (40 vs 48.6 years, p = 0.002) and came to resection more quickly from the time of admission (5.44 vs 8.61 days, p < 0.001). The number of emergency colectomies for IBD were 54 in 2000–04, 95 in 2005–09, and 59 in 2010–14. There were 10 inpatient deaths postoperatively (4.8%), and these patients were significantly older (mean age 72.9 vs. 41.7, p < 0.001) with more comorbidity (mean Charlson score = 10.3 vs. 1.51, p = 0.003). The mortality rate has fallen over the same period from 5.6% (00–04), 7.4% (05–09), to 0.0% (10–14). Mortality was significantly higher with delay to theatre, with those that died being operated on at 13.2 vs. 6.2 days (mean) from admission (p = 0.049)
Conclusion Emergency colectomy mortality rates have fallen over the last 14 years. To improve survival further efforts must be made to identify patients requiring surgery sooner. The elderly and those with increased co-morbidity represent a particularly high risk group.
Disclosure of interest None Declared.