Twenty-seven percent of patients who are treated for ulcerative colitis by colectomy experience postoperative complications, according to a study in the November issue of Clinical Gastroenterology and Hepatology.
Most patients with ulcerative colitis are successfully treated with medication, yet some have severe colitis attacks that can be life threatening. Approximately 10% of patients with colitis therefore receive a colectomy (surgical removal of all or part of the colon) within the first 10 years of diagnosis. However, it is not clear how many people experience complications from this surgery, or what the risk factors are.
Shanika De Silva et al. performed a population-based study to determine the occurrence and severity of postoperative complications and identify factors that affect outcome.
Analyzing 14 years of data, from 666 patients with ulcerative colitis who received colectomies, the authors found that a postoperative complication occurred in 27.0% and the mortality rate was 1.5%. The risk for complications was greatest among patients more than 64 years or with other health complications, such as a history of cardiac disease.
Furthermore, patients with colitis who were admitted to the hospital under emergency conditions and did not respond to medical treatment had worse outcomes when surgery was performed 14 or more days after admission. Patients who underwent emergent surgery because they did not respond to in-hospital medical management, or developed an acute complication, had worse outcomes (2.4% mortality) than patients who had elective surgeries.
Patients who receive immunosuppressants or other drugs for inflammatory bowel diseases (mesalamine, corticosteroids, azathioprine, 6-mercaptopurine, or infliximab) do not have an increased risk for postoperative complications, including infections. Institutions that performed less than 4 colectomies in patients with ulcerative colitis per year had 2-fold greater postoperative mortality than high-volume hospitals that performed surgery on greater than 12 patients per year.
De Silva et al. conclude that it is important to carefully select patients for colectomies. Elderly patients and those with other diseases should be offered comprehensive medical management, and other strategies should be considered before colectomy.
The authors state that elective colectomies have the best outcomes, so gastroenterologists and surgeons should try to optimize management of patients, making timely decisions for surgery in the outpatient setting.
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De Silva S, Ma C, Proulx M-C, et al. Postoperative complications and mortality following colectomy for ulcerative colitis. Clin Gastroenterol and Hepatol 2011; 9:972–980