BACKGROUND: New medical therapies available to ulcerative colitis (UC) patients have influenced operative mortality for patients requiring colectomy. We sought to examine trends in treatment and outcome for UC patients treated surgically. METHODS: A review of 36,447 UC patients from the Nationwide Inpatient Sample was performed, comparing the pre-monoclonal antibody era (1990-1996) to the present-day era (2000-2006). Patients treated with total colectomy with ileostomy or proctocolectomy with ileal pouch were reviewed for outcome measures and practice setting (rural, urban non-teaching, urban teaching). Our main outcome measures were in-hospital mortality, length of stay, and total charges. RESULTS: Total colectomy (n = 30,362) was performed five times more often than proctocolectomy (n = 6,085). When comparing the two study periods, mortality after total colectomy increased 3.8% to 4.6% (p = 0.0003). This difference was primarily due to increasing mortality in later years; when 1995-1996 was compared to 2005-2006, mortality increased from 3.6% to 5.6% (p < 0.0001). There were no deaths in the proctocolectomy group (p < 0.0001). The distribution by practice setting shifted over the two study periods, decreasing in rural (7.0% to 4.8%) and urban non-teaching (43.7% to 28.4%) centers, and increasing in urban teaching centers (49.3% to 66.8%). The total inflation-adjusted charges per patient increased significantly ($34,638 vs. $43,621; p < 0.0001). CONCLUSIONS: The mortality rate after total colectomy is increasing, and the difference is accentuated in the years since widespread use of monoclonal antibody therapy. The care of these patients is being shifted to urban teaching centers and is becoming more expensive.
BACKGROUND: New medical therapies available to ulcerative colitis (UC) patients have influenced operative mortality for patients requiring colectomy. We sought to examine trends in treatment and outcome for UC patients treated surgically. METHODS: A review of 36,447 UC patients from the Nationwide Inpatient Sample was performed, comparing the pre-monoclonal antibody era (1990-1996) to the present-day era (2000-2006). Patients treated with total colectomy with ileostomy or proctocolectomy with ileal pouch were reviewed for outcome measures and practice setting (rural, urban non-teaching, urban teaching). Our main outcome measures were in-hospital mortality, length of stay, and total charges. RESULTS: Total colectomy (n = 30,362) was performed five times more often than proctocolectomy (n = 6,085). When comparing the two study periods, mortality after total colectomy increased 3.8% to 4.6% (p = 0.0003). This difference was primarily due to increasing mortality in later years; when 1995-1996 was compared to 2005-2006, mortality increased from 3.6% to 5.6% (p < 0.0001). There were no deaths in the proctocolectomy group (p < 0.0001). The distribution by practice setting shifted over the two study periods, decreasing in rural (7.0% to 4.8%) and urban non-teaching (43.7% to 28.4%) centers, and increasing in urban teaching centers (49.3% to 66.8%). The total inflation-adjusted charges per patient increased significantly ($34,638 vs. $43,621; p < 0.0001). CONCLUSIONS: The mortality rate after total colectomy is increasing, and the difference is accentuated in the years since widespread use of monoclonal antibody therapy. The care of these patients is being shifted to urban teaching centers and is becoming more expensive.
Authors: William J Sandborn; Paul Rutgeerts; Brian G Feagan; Walter Reinisch; Allan Olson; Jewel Johanns; Jiandong Lu; Kevin Horgan; Daniel Rachmilewitz; Stephen B Hanauer; Gary R Lichtenstein; Willem J S de Villiers; Daniel Present; Bruce E Sands; Jean Frédéric Colombel Journal: Gastroenterology Date: 2009-07-28 Impact factor: 22.682
Authors: Chelliah R Selvasekar; Robert R Cima; David W Larson; Eric J Dozois; Jeffrey R Harrington; William S Harmsen; Edward V Loftus; William J Sandborn; Bruce G Wolff; John H Pemberton Journal: J Am Coll Surg Date: 2007-05 Impact factor: 6.113
Authors: A Aratari; C Papi; V Clemente; A Moretti; R Luchetti; M Koch; L Capurso; R Caprilli Journal: Dig Liver Dis Date: 2008-05-09 Impact factor: 4.088
Authors: E A Russo; A W Harris; S Campbell; J Lindsay; A Hart; N Arebi; A Milestone; H H Tsai; J Walters; M Carpani; D Westaby; A Thillainayagam; D Bansi; S Ghosh Journal: Aliment Pharmacol Ther Date: 2008-11-13 Impact factor: 8.171
Authors: Stefanie J Schluender; Andrew Ippoliti; Marla Dubinsky; Eric A Vasiliauskas; Konstantinos A Papadakis; Ling Mei; Stephan R Targan; Phillip R Fleshner Journal: Dis Colon Rectum Date: 2007-11 Impact factor: 4.585
Authors: Hunter B Moore; Ernest E Moore; Mark R Nehler; Lisa C Cicutto; Anthony W Bacon; Claire Travis; Richard D Schulick Journal: J Am Coll Surg Date: 2013-11-12 Impact factor: 6.113