I Ordás1, E Domènech1, M Mañosa1, V García-Sánchez1, E Iglesias-Flores1, F Rodríguez-Moranta1, L Márquez1, O Merino1, F Fernández-Bañares1, F Gomollón1, M Vera1, A Gutiérrez1, J LLaó1, J P Gisbert1, M Aguas1, L Arias1, I Rodríguez-Lago1, C Muñoz1, N Alcaide1, X Calvet1, C Rodríguez1, M A Montoro1, S García1, M L De Castro1, M Piqueras1, L Pareja1, J Ribes1,1,1, J Panés1, M Esteve1. 1. Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain. Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, CIBEREHD, Barcelona, Spain. Hospital Reina Sofía, IMIBIC, Cordoba's Univeristy, Cordoba, Spain. Gastroenterology Department, Hospital Universitario de Bellvitge, Barcelona, Spain. Gastroenterology Department, Hospital del Mar, Barcelona, Spain. Gastroenterology Department, Hospital de Cruces, Bilbao, Spain. Gastroenterology Department, Hospital Universitari Mútua Terrassa, CIBEREHD, Barcelona, Spain. Gastroenterology Department, Hospital Lozano Blesa, CIBEREHD, Zaragoza, Spain. Gastroenterology Department, Hospital Puerta de Hierro Majadahonda, Madrid, Spain. Gastroenterology Department, Hospital Universitario de Alicante, CIBEREHD, Alicante, Spain. Gastroenterology Department, Hospital de Sant Pau, Barcelona, Spain. Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, CIBEREHD, Madrid, Spain. Gastroenterology Department, Hospital la Fe, CIBEREHD, Valencia, Spain. Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain. Gastroenterology Department, Hospital de Galdakao, Bilbao, Spain. Gastroenterology Department, Hospital de Basurto, Bilbao, Spain. Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, CIBEREHD, Barcelona, Spain. Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain. Gastroenterology Department, Hospital San Jorge, Huesca, Spain. Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain. Gastroenterology Department, Complexo Hospitalario Universitario de Vigo-Instituto de Investigación Biomédica, Pontevedra, Spain. Gastroenterology Department, Consorci Sanitari de Terrassa, Barcelona, Spain. Catalonian Cancer Registry, Oncologist Director Plan of Catalonia, Barcelona, Spain. Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain. Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
Abstract
BACKGROUND: Despite the increased use of rescue medical therapies for steroid refractory acute severe ulcerative colitis, mortality related to this entity still remains high. We aimed to assess the mortality and morbidity related to colectomy and their predictive factors in steroid refractory acute severe ulcerative colitis, and to evaluate the changes in mortality rates, complications, indications of colectomy, and the use of rescue therapy over time. METHODS: We performed a multicenter observational study of patients with steroid refractory acute severe ulcerative colitis requiring colectomy, admitted to 23 Spanish hospitals included in the ENEIDA registry (GETECCU) from 1989 to 2014. Independent predictive factors of mortality were assessed by binary logistic regression analysis. Mortality along the study was calculated using the age-standardized rate. RESULTS: During the study period, 429 patients underwent colectomy, presenting an overall mortality rate of 6.3% (range, 0-30%). The main causes of death were infections and post-operative complications. Independent predictive factors of mortality were: age ≥50 years (OR 23.34; 95% CI: 6.46-84.311; p < 0.0001), undergoing surgery in a secondary care hospital (OR 3.07; 95% CI: 1.01-9.35; p = 0.047), and in an emergency setting (OR 10.47; 95% CI: 1.26-86.55; p = 0.029). Neither the use of rescue medical treatment nor the type of surgical technique used (laparoscopy vs. open laparotomy) influenced mortality. The proportion of patients undergoing surgery in an emergency setting decreased over time (p < 0.0001), whereas the use of rescue medical therapy prior to colectomy progressively increased (p > 0.001). CONCLUSIONS: The mortality rate related to colectomy in steroid refractory acute severe ulcerative colitis varies greatly among hospitals, reinforcing the need for a continuous audit to achieve quality standards. The increasing use of rescue therapy is not associated with a worse outcome and may contribute to reducing emergency surgical interventions and improve outcomes.
BACKGROUND: Despite the increased use of rescue medical therapies for steroid refractory acute severe ulcerative colitis, mortality related to this entity still remains high. We aimed to assess the mortality and morbidity related to colectomy and their predictive factors in steroid refractory acute severe ulcerative colitis, and to evaluate the changes in mortality rates, complications, indications of colectomy, and the use of rescue therapy over time. METHODS: We performed a multicenter observational study of patients with steroid refractory acute severe ulcerative colitis requiring colectomy, admitted to 23 Spanish hospitals included in the ENEIDA registry (GETECCU) from 1989 to 2014. Independent predictive factors of mortality were assessed by binary logistic regression analysis. Mortality along the study was calculated using the age-standardized rate. RESULTS: During the study period, 429 patients underwent colectomy, presenting an overall mortality rate of 6.3% (range, 0-30%). The main causes of death were infections and post-operative complications. Independent predictive factors of mortality were: age ≥50 years (OR 23.34; 95% CI: 6.46-84.311; p < 0.0001), undergoing surgery in a secondary care hospital (OR 3.07; 95% CI: 1.01-9.35; p = 0.047), and in an emergency setting (OR 10.47; 95% CI: 1.26-86.55; p = 0.029). Neither the use of rescue medical treatment nor the type of surgical technique used (laparoscopy vs. open laparotomy) influenced mortality. The proportion of patients undergoing surgery in an emergency setting decreased over time (p < 0.0001), whereas the use of rescue medical therapy prior to colectomy progressively increased (p > 0.001). CONCLUSIONS: The mortality rate related to colectomy in steroid refractory acute severe ulcerative colitis varies greatly among hospitals, reinforcing the need for a continuous audit to achieve quality standards. The increasing use of rescue therapy is not associated with a worse outcome and may contribute to reducing emergency surgical interventions and improve outcomes.
Authors: Roni Weisshof; Jacob E Ollech; Katia El Jurdi; Olivia V Yvellez; Russell D Cohen; Atsushi Sakuraba; Sushila Dalal; Joel Pekow; David T Rubin Journal: J Crohns Colitis Date: 2019-09-19 Impact factor: 9.071
Authors: C Schineis; K S Lehmann; J C Lauscher; K Beyer; L Hartmann; G A Margonis; J Michel; C E Degro; F N Loch; F Speichinger; M E Kreis; C Kamphues Journal: Int J Colorectal Dis Date: 2019-12-21 Impact factor: 2.571
Authors: Belinda De Simone; Justin Davies; Elie Chouillard; Salomone Di Saverio; Frank Hoentjen; Antonio Tarasconi; Massimo Sartelli; Walter L Biffl; Luca Ansaloni; Federico Coccolini; Massimo Chiarugi; Nicola De'Angelis; Ernest E Moore; Yoram Kluger; Fikri Abu-Zidan; Boris Sakakushev; Raul Coimbra; Valerio Celentano; Imtiaz Wani; Tadeja Pintar; Gabriele Sganga; Isidoro Di Carlo; Dario Tartaglia; Manos Pikoulis; Maurizio Cardi; Marc A De Moya; Ari Leppaniemi; Andrew Kirkpatrick; Vanni Agnoletti; Gilberto Poggioli; Paolo Carcoforo; Gian Luca Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2021-05-11 Impact factor: 5.469