Introduction One in four patients with ulcerative colitis (UC) may require surgery, but this figure is probably declining following NICE approval of biologics for acute severe (2008) and moderate (2015) UC. The IBD service standards (2009) advocate laparoscopic surgery where possible and advise auditing surgical outcomes. A retrospective audit of colectomy for UC in Leeds over the decade 2005–2015 was performed.
Method Patients undergoing colectomy were identified from histology databases. Data on timing (elective, urgent (during admission with acute severe UC), or emergency (within 48 hours of admission for acute severe UC)), indication, and nature of the index procedure, grade of operator, surgical approach used, prior biologics, and complication rates were collected. Results for 2005–2009 were compared with 2010–2015 using a Chi2 test.
Results 178 colectomies were performed between 2005 and 2015. 99 (55.6%) were elective (76 (76.8%) for failed medical therapy, 22 (22.2%) for dysplasia). 61 (34.3%) were urgent and 18 (10.1%) were emergency cases. Overall, 81 (47%) colectomies were performed laparoscopically (64 (68%) of elective cases vs. 17 (22%) of urgent/emergency cases (p<0.0001)). When comparing 2005–2009 with 2010–2015 there was a reduction in number of colectomies performed (98 vs. 80). Over the two time periods, rates of laparoscopic surgery increased from 42% to 53% (p=0.16). Number of elective colectomies fell from 63 to 36 over the decade, although those done laparoscopically increased (57% vs. 78% (p=0.04)). Urgent/emergency operations rose from 35 to 44 cases (36% v 55% (p=0.01)). Only 6 (9.5%) out of 63 elective colectomies between 2005–2009 had received biologics, compared with 14 (38.9%) out of 36 in 2010–2015 (p=0.0005). However, there was no difference in the use of rescue therapy in urgent cases between these time periods, reflecting our use of ciclosporin pre-biologics. The overall mortality rate was 4.5% (8 of 178), but was lowest for elective surgery (1.0% (1 of 99) vs. 6.6% (4 of 61) for urgent and 16.7% (3 of 18) for emergency cases (p=0.008)). 30 day mortality (3% v 6%, p=0.3), infection (11% vs. 17.5%, p=0.23), and venous thromboembolism (1% both groups) rates were unchanged between the two eras. The surgical approach did not influence early post-operative complications. However, length of stay was significantly lower following laparoscopic surgery (15.7 vs. 23 days, p=0.002).
Conclusion Fewer elective colectomies are being performed for UC, possibly attributed to increased biologic use. A greater proportion are done laparoscopically, with shorter lengths of stay. However, a significant greater proportion of patients are requiring urgent/emergency surgery, where mortality is higher.
Disclosure of Interest None Declared
- Inflammatory Bowel Disease
- Ulcerative colitis
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