PURPOSE: Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients. METHODS: We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy. RESULTS: Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08). CONCLUSION: These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.
PURPOSE:Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients. METHODS: We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy. RESULTS: Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08). CONCLUSION: These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.
Authors: Klaudia Farkas; Ferenc Nagy; Zoltán Szepes; Tibor Nyári; Tibor Wittmann; Tamás Molnár Journal: Inflamm Bowel Dis Date: 2011-02 Impact factor: 5.325
Authors: Jill C Moore; Kimberly Thompson; Bonnie Lafleur; Linda S Book; W Daniel Jackson; Molly A O'Gorman; Richard E Black; Earl Downey; Dale G Johnson; Michael E Matlak; Rebecka L Meyers; Eric Scaife; Stephen L Guthery Journal: Inflamm Bowel Dis Date: 2011-01 Impact factor: 5.325
Authors: Jeffrey S Hyams; Michael Brimacombe; Yael Haberman; Thomas Walters; Greg Gibson; Angela Mo; David Mack; Anne Griffiths; Brendan Boyle; Neal LeLeiko; James Markowitz; Joel Rosh; Ashish Patel; Sapana Shah; Robert Baldassano; Marian Pfefferkorn; Cary Sauer; Joelynn Dailey; Suresh Venkateswaran; Subra Kugathasan; Lee A Denson Journal: Inflamm Bowel Dis Date: 2022-02-01 Impact factor: 5.325