Caitlin W Hicks1, Richard A Hodin2, Liliana Bordeianou3. 1. Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA; The Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, USA. 2. Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA. 3. Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA. Electronic address: lbordeianou@partners.org.
Abstract
BACKGROUND: Surgeons frequently discourage patients with ulcerative colitis from having surgery in the midst of an acute flare for fear of complications and poor long-term outcomes. METHODS: Outcomes of patients undergoing urgent versus elective surgery for ulcerative colitis were compared via retrospective review. RESULTS: Patients undergoing urgent (n = 80) versus elective (n = 99) surgery were younger, were more malnourished, had more severe active disease, and had higher steroid use (P ≤ .05). During surgery, hemodynamic stability was similar, but urgent patients underwent more subtotal colectomies (5.1% vs 29%, P < .0001) and fewer laparoscopic procedures (8.8% vs 18%, P = .07). Multivariate regression suggested that short-term complications were increased with higher body mass index and urgency status (P ≤ .05). Anastomotic leaks and long-term complications were similar between groups. Surgeon inexperience and use of immunomodulators other than infliximab were associated with increased odds of long-term fistula/abscess (odds ratio, 5.56; P = .05] and pouch failure (odds ratio, 13.3; P = .01). CONCLUSIONS: Surgery in patients with acute ulcerative colitis flares is associated with more short-term complications than elective procedures but does not appear to affect risk for anastomotic leak or long-term complications when performed by an expert.
BACKGROUND: Surgeons frequently discourage patients with ulcerative colitis from having surgery in the midst of an acute flare for fear of complications and poor long-term outcomes. METHODS: Outcomes of patients undergoing urgent versus elective surgery for ulcerative colitis were compared via retrospective review. RESULTS:Patients undergoing urgent (n = 80) versus elective (n = 99) surgery were younger, were more malnourished, had more severe active disease, and had higher steroid use (P ≤ .05). During surgery, hemodynamic stability was similar, but urgent patients underwent more subtotal colectomies (5.1% vs 29%, P < .0001) and fewer laparoscopic procedures (8.8% vs 18%, P = .07). Multivariate regression suggested that short-term complications were increased with higher body mass index and urgency status (P ≤ .05). Anastomotic leaks and long-term complications were similar between groups. Surgeon inexperience and use of immunomodulators other than infliximab were associated with increased odds of long-term fistula/abscess (odds ratio, 5.56; P = .05] and pouch failure (odds ratio, 13.3; P = .01). CONCLUSIONS: Surgery in patients with acute ulcerative colitis flares is associated with more short-term complications than elective procedures but does not appear to affect risk for anastomotic leak or long-term complications when performed by an expert.
Authors: Grace C Lee; Sarah E Deery; Hiroko Kunitake; Caitlin W Hicks; Adriana G Olariu; Lieba R Savitt; Ashwin N Ananthakrishnan; Rocco Ricciardi; Richard A Hodin; Liliana G Bordeianou Journal: Int J Colorectal Dis Date: 2019-01-04 Impact factor: 2.571