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Early surgery improves outcomes in acute ulcerative colitis
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Postoperative complications and longer hospital stays were more common in patients with acute ulcerative colitis for whom surgery was delayed, according to retrospective study data presented at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting.
Study investigators concluded that early surgical intervention should therefore be considered in patients who are hospitalized for severe acute ulcerative colitis.
“The current paradigm for acute ulcerative colitis is trialing medical therapy prior to urgent surgical intervention after approximately 5 to 7 days of failed improvement,” Ira Leeds, MD, MBA, of the department of surgery at Johns Hopkins University School of Medicine, told Healio Gastroenterology. “We used nationwide administrative data to ask whether even a few days of deferred [surgery] may be associated with worse postoperative outcomes.”
Ira Leeds
Leeds and colleagues reviewed patients with a principal diagnosis of ulcerative colitis who were hospitalized and underwent emergency surgery between 2008 and 2013. Of the 225,154 patients who were admitted for UC during this time, 6,819 underwent emergency surgery, 27% of whom had early operations, occurring within 24 hours of admission during the work-week or 48 hours of admission during the weekend. The investigators noted that early surgeries were more common in men and in patients from higher income households.
Of note, the researchers observed a lower rate of complications (43.2% vs. 54.9%; P < .001) and shorter hospital stays (8.2% vs. 28.6% admitted longer than 21 days; P <.001) among patients who underwent early surgery. Specifically, patients who underwent early surgery had fewer renal (8.4% vs. 14.3%; P < 0.001), pulmonary (20.2% vs. 25.4%; P = 0.015) and thromboembolic events (3.5% vs. 6%; P = 0.024), but mortality rates were comparable. Further, early surgeries were associated with lower median total costs ($19,985 vs. $34,258; P < 0.001).
Multivariable logistic regression showed complication rates were associated with older age (OR = 1.43) and delayed surgery (OR = 1.64), and longer hospital stays were independently associated with older age (OR = 1.14), male sex (OR = 1.36) and delayed surgery (OR = 4.57). Higher hospital costs were also independently associated with complications (OR = 1.41) and longer hospital stays (OR = 5.75).
“The association between better outcomes and immediate surgery (ie, within 24 hours of admission) was maintained after controlling for demographic and clinically relevant differences in the study population,” Leeds said. “In the intermediate term, these retrospective findings provide the necessary clinical equipoise to implement a prospective trial that accelerates the urgency from acute ulcerative colitis patient presentation and surgical intervention. In the near term, these findings have already led me to reconsider the urgency of a gastroenterologists’ consult request for surgical intervention after failed medical therapy trial. These findings suggest that time is of the essence following consultation for surgical intervention for acute ulcerative colitis, and that any delay may potentially be worsening one’s postoperative outcome.” – by Adam Leitenberger
Reference:
Leeds I, et al. Abstract S18. Presented at: American Society of Colon and Rectal Surgeons Annual Scientific Meeting; June 10-14, 2017; Seattle.
Disclosures: The researchers report no relevant financial disclosures.