Semi-urgent surgery in hospitalized patients with severe ulcerative colitis does not increase overall J-pouch complications - 28/01/14

Doi : 10.1016/j.amjsurg.2013.06.006

Caitlin W. Hicks, M.D., M.S. ^a,^b, Richard A. Hodin, M.D. ^a, Liliana Bordeianou, M.D., M.P.H. ^a,^⁎
^a Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA
^b The Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, USA

^∗Corresponding author. Tel.: +1-617-643-0541; fax: +1-617-643-0508.

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.

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Keywords : Ulcerative colitis, Surgery for IBD, Complications of IBD