Skip to main content

Advertisement

SpringerLink
Log in

Mortality Is Rare Following Elective and Non-elective Surgery for Ulcerative Colitis, but Mild Postoperative Complications Are Common

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background Data

Currently, data regarding the rates of morbidity and mortality following non-elective colectomy for ulcerative colitis (UC) are variable. We sought to determine the rates and predictors of 90-day mortality and complications following colectomy for UC.

Methods

Patients undergoing an initial surgery for UC at a tertiary care center between January 2002 and January 2014 were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for mortality and complications within 90 days of surgery. Complications were classified using the Clavien–Dindo classification system. Univariate and multivariate analyses were performed using IBM SPSS Statistics, version 23.0.

Results

Two hundred and fifty-eight patients underwent surgery for UC. 69% were elective, and 31% were urgent/emergent. There were no deaths reported within 30 days of surgery. At 90 days, there were 2 deaths in the elective group and 1 death in the urgent/emergent group. The death in the urgent/emergent group was likely related to the initial surgery, while the elective group death was not directly related to the initial surgery for UC. Complications occurred in 47% of patients. There were no significant differences in rates of complications in either surgical cohort. Majority (62%) of the complications were Clavien–Dindo grade 1 or 2 with no difference in the elective or urgent/emergent group. Unplanned readmissions occurred in 24% of cases.

Conclusion

Surgery for UC is not associated with any mortality at 30 days and very low mortality at 90 days. However, surgery is associated with an increased rate of minor postoperative complications and readmissions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American college of gastroenterology, practice parameters committee. Am J Gastroenterol. 2010;105:501–523.

    Article  PubMed  Google Scholar 

  2. Ross H, Steele SR, Varma M, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2014;57:5–22.

    Article  PubMed  Google Scholar 

  3. Øresland T, Bemelman WA, Sampietro GM, et al. European evidence based consensus on surgery for ulcerative colitis. J Crohn’s Colitis. 2015;9:4–25.

    Google Scholar 

  4. Bernstein CN, Ng SC, Lakatos PL, Moum B, Loftus EV Jr. A review of mortality and surgery in ulcerative colitis: milestones of the seriousness of the disease. Inflamm Bowel Dis. 2013;19:2001–2010.

    PubMed  Google Scholar 

  5. Hovde Ø, Småstuen MC, Høivik ML, et al. Mortality and causes of death in ulcerative colitis: results from 20 years of follow-up in the IBSEN Study. Inflamm Bowel Dis. 2016;22:141–145.

    Article  PubMed  Google Scholar 

  6. Nguyen GC, Bernstein CN, Benchimol EI. Risk of surgery and mortality in elderly-onset inflammatory bowel disease: a population-based cohort study. Inflamm Bowel Dis. 2017;23:218–223.

    Article  PubMed  Google Scholar 

  7. Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative colitis patients with Clostridium difficile are at increased risk of death, colectomy, and postoperative complications: a population-based inception cohort study. Am J Gastroenterol. 2016;111:691–704.

    Article  PubMed  Google Scholar 

  8. Bitton A, Vutcovici M, Sewitch M, Suissa S, Brassard P. Mortality trends in Crohn’s disease and ulcerative colitis: a population-based study in Quebec, Canada. Inflamm Bowel Dis. 2016;22:416–423.

    Article  PubMed  Google Scholar 

  9. Singh S, Al-Darmaki A, Frolkis AD, et al. Postoperative Mortality among patients with inflammatory bowel diseases: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2015;149:928–937.

    Article  PubMed  Google Scholar 

  10. Kaplan GG, McCarthy EP, Ayanian JZ, Korzenik J, Hodin R, Sands BE. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology. 2008;134:680–687.

    Article  PubMed  Google Scholar 

  11. Frolkis A, Kaplan GG, Patel AB, Faris P, Quan H, Jette N. Postoperative Complications and emergent readmission in children and adults with inflammatory bowel disease who undergo intestinal resection: a population-based study. Inflamm Bowel Dis. 2014;20:1316–1323.

    Article  PubMed  Google Scholar 

  12. Gu J, Stocchi L, Remzi F, Kiran RP. Factors associated with postoperative morbidity, reoperation and readmission rates after laparoscopic total abdominal colectomy for ulcerative colitis. Colorectal Dis. 2013;15:1123–1129.

    Article  CAS  PubMed  Google Scholar 

  13. Feuerstein JD, Jiang ZG, Belkin E, et al. Surgery for ulcerative colitis is associated with a high rate of readmissions at 30 days. Inflamm Bowel Dis. 2015;21:2130–2136.

    Article  PubMed  Google Scholar 

  14. de Silva S, Ma C, Proulx MC, et al. Postoperative complications and mortality following colectomy for ulcerative colitis. Clin Gastroenterol Hepatol. 2011;9:972–980.

    Article  PubMed  Google Scholar 

  15. Kirchhoff P, Clavien P-A, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4:5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Truelove S. Cortisone in ulcerative colitis. Preliminary report on a therapeutic trial. Gastroenterologia. 1954;81:86–90.

    Article  CAS  PubMed  Google Scholar 

  17. Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465–483.

    Article  PubMed  Google Scholar 

  18. Hsu C-C, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007;12:1–8.

    Google Scholar 

  19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377.

    Article  PubMed  Google Scholar 

  20. Feuerstein JD, Shah S, Najarian R, Nagle D, Moss AC. A fatal case of diffuse enteritis after colectomy for ulcerative colitis: a case report and review of the literature. Am J Gastroenterol. 2014;109:1086.

    Article  PubMed  Google Scholar 

  21. Lindsay J, Bergman A, Patel A, Alesso S, Peyrin-Biroulet L. Systematic review: the financial burden of surgical complications in patients with ulcerative colitis. Aliment Pharmacol Ther. 2015;41:1066–1078.

    Article  CAS  PubMed  Google Scholar 

  22. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Billioud V, Ford AC, Del Tedesco E, Colombel J-F, Roblin X, Peyrin-Biroulet L. Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohn’s Colitis. 2013;7:853–867.

    Article  Google Scholar 

  24. Nørgård BM, Nielsen J, Qvist N, Gradel K, Muckadell O, Kjeldsen J. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with Crohn’s disease—a nationwide cohort study. Aliment Pharmacol Ther. 2013;37:214–224.

    Article  PubMed  Google Scholar 

  25. Myrelid P, Olaison G, Sjödahl R, Nyström P-O, Almer S, Andersson P. Thiopurine therapy is associated with postoperative intra-abdominal septic complications in abdominal surgery for Crohn’s disease. Dis Colon Rectum. 2009;52:1387–1394.

    Article  PubMed  Google Scholar 

  26. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196.

    Article  PubMed  Google Scholar 

  27. Vonlanthen R, Slankamenac K, Breitenstein S, et al. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg. 2011;254:907–913.

    Article  PubMed  Google Scholar 

  28. Feuerstein JD, Castillo NE, Siddique SS, et al. Poor documentation of inflammatory bowel disease quality measures in academic, community, and private practice. Clin Gastroenterol Hepatol. 2016;14:421–428.

    Article  PubMed  Google Scholar 

  29. Donzé J, Lipsitz S, Bates DW, Schnipper JL. Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study. BMJ. 2013;347:f7171.

    Article  PubMed  PubMed Central  Google Scholar 

  30. McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation. 2015;131:1796–1803.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Nagle D, Pare T, Keenan E, Marcet K, Tizio S, Poylin V. Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum. 2012;55:1266–1272.

    Article  PubMed  Google Scholar 

  32. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369:1134–1142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Feuerstein JD, Martínez-Vazquez M, Belkin E, Singla A, Cheifetz AS. Su1103 30 day readmissions rate and predictors of readmission in hospitalized patients with ulcerative colitis. Gastroenterology. 2014;146:S-375.

    Article  Google Scholar 

Download references

Author’s contribution

JDF and VP had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JDF, VP, T Cataldo, and KRF conceived and designed the study; JDF, MA, and T Curran acquired the data; JDF, VP, T Cataldo, T Curran, and KRF analyzed and interpreted the data; JDF and T Curran drafted the manuscript; JDF, MA, KRF, VP, and T Cataldo critically revised the manuscript for important intellectual content; T Curran performed the statistical analysis; JDF and VP supervised the study; and each author has approved the final draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street 8E Gastroenterology, Boston, MA, 02215, USA

    Joseph D. Feuerstein & Kenneth R. Falchuk

  2. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Thomas Curran & Michael Alosilla

  3. Department of Surgery and Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Thomas Cataldo & Vitaliy Poylin

Authors
  1. Joseph D. Feuerstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Curran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Alosilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Cataldo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenneth R. Falchuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vitaliy Poylin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph D. Feuerstein.

Ethics declarations

Conflict of interest

None of the authors have any relevant conflicts of interest related to this manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feuerstein, J.D., Curran, T., Alosilla, M. et al. Mortality Is Rare Following Elective and Non-elective Surgery for Ulcerative Colitis, but Mild Postoperative Complications Are Common. Dig Dis Sci 63, 713–722 (2018). https://doi.org/10.1007/s10620-018-4922-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-4922-x

Keywords

Search

Navigation