OBJECTIVES: Previous studies have reported colectomy rates of over 50% in ulcerative colitis (UC), although changes in management may have influenced the rates of colectomy in the modern era. We sought to determine the incidence of colectomy in UC and identify risk factors associated with early colectomy (EC) and late colectomy (LC). METHODS: We used the University of Manitoba Inflammatory Bowel Disease Epidemiology Database, a population-based data set including UC patients with up to 25 years of post diagnosis follow-up. We tracked the occurrence of total colectomy in all patients with known UC, subdivided into EC (≤90 days from diagnosis date) and LC (>90 days from diagnosis). Survival curves were created and stratified by age, sex, era of diagnosis, and inpatient/hospital diagnosis. Cox proportional hazards modeling was used to determine which risk factors were predictive of either EC or LC. RESULTS: Among 3,752 patients with UC, 367 underwent colectomy. The 5-, 10- and 20-year actuarial risk of requiring colectomy was 7.5%, 10.4%, and 14.8%, respectively. Male sex (hazard ratio (HR): 2.63, [corrected] 95% confidence interval (CI): 1.58-4.36) and being initially diagnosed during a hospitalization (HR: 12.46, 95% CI: 7.40-21.0) were predictive of EC after adjustment for confounders. In-hospital diagnosis was predictive of LC, whereas being diagnosed more recently was protective against LC (HR: 0.96, 95% CI: 0.93-0.98). CONCLUSIONS: The cumulative incidence of colectomy in UC is lower than previously reported, and appears to be decreasing further among more recently diagnosed cohorts of patients. Male sex and hospitalization at the time of diagnosis are major risk factors for EC and LC.
OBJECTIVES: Previous studies have reported colectomy rates of over 50% in ulcerative colitis (UC), although changes in management may have influenced the rates of colectomy in the modern era. We sought to determine the incidence of colectomy in UC and identify risk factors associated with early colectomy (EC) and late colectomy (LC). METHODS: We used the University of Manitoba Inflammatory Bowel Disease Epidemiology Database, a population-based data set including UC patients with up to 25 years of post diagnosis follow-up. We tracked the occurrence of total colectomy in all patients with known UC, subdivided into EC (≤90 days from diagnosis date) and LC (>90 days from diagnosis). Survival curves were created and stratified by age, sex, era of diagnosis, and inpatient/hospital diagnosis. Cox proportional hazards modeling was used to determine which risk factors were predictive of either EC or LC. RESULTS: Among 3,752 patients with UC, 367 underwent colectomy. The 5-, 10- and 20-year actuarial risk of requiring colectomy was 7.5%, 10.4%, and 14.8%, respectively. Male sex (hazard ratio (HR): 2.63, [corrected] 95% confidence interval (CI): 1.58-4.36) and being initially diagnosed during a hospitalization (HR: 12.46, 95% CI: 7.40-21.0) were predictive of EC after adjustment for confounders. In-hospital diagnosis was predictive of LC, whereas being diagnosed more recently was protective against LC (HR: 0.96, 95% CI: 0.93-0.98). CONCLUSIONS: The cumulative incidence of colectomy in UC is lower than previously reported, and appears to be decreasing further among more recently diagnosed cohorts of patients. Male sex and hospitalization at the time of diagnosis are major risk factors for EC and LC.
Authors: Venkata Subhash Gorrepati; Sanjay Yadav; August Stuart; Walter Koltun; Evangelos Messaris; Emmanuelle D Williams; Matthew D Coates Journal: Int J Colorectal Dis Date: 2018-06-29 Impact factor: 2.571
Authors: Millie D Long; Susan Hutfless; Michael D Kappelman; Hamed Khalili; Gilaad G Kaplan; Charles N Bernstein; Jean Frederic Colombel; Corinne Gower-Rousseau; Lisa Herrinton; Fernando Velayos; Edward V Loftus; Geoffrey C Nguyen; Ashwin N Ananthakrishnan; Amnon Sonnenberg; Andrew Chan; Robert S Sandler; Ashish Atreja; Samir A Shah; Kenneth J Rothman; Neal S Leleiko; Renee Bright; Paolo Boffetta; Kelly D Myers; Bruce E Sands Journal: Inflamm Bowel Dis Date: 2014-02 Impact factor: 5.325