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Trends in Morbidity and Mortality Following Colectomy Among Patients with Ulcerative Colitis in the Biologic Era (2002–2013): A Study Using the National Inpatient Sample

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Abstract

Background

Total abdominal colectomy (TAC) is a treatment modality of last recourse for patients with severe and/or refractory ulcerative colitis (UC). The goal of this study is to evaluate temporal trends and treatment outcomes following TAC among hospitalized UC patients in the biologic era.

Methods

We queried the National Inpatient Sample (NIS) to identify patients older than 18 years with a primary diagnosis of ulcerative colitis (UC) who underwent TAC between 2002 and 2013. We evaluated postoperative morbidity and mortality as outcomes of interest. Logistic regression was used to explore factors associated with postoperative morbidity and mortality after TAC.

Results

A weighted total of 307,799 UC hospitalizations were identified. Of these, 27,853 (9%) resulted in TAC. Between 2002 and 2013, hospitalizations for UC increased by over 70%; however, TAC rates dropped significantly from 111.1 to 77.1 colectomies per 1000 UC admissions. Overall, 2.2% of patients died after TAC. Mortality rates after TAC decreased from 3.5% in 2002 to 1.4% in 2013. Conversely, morbidity rates were stable throughout the study period. UC patients with emergent admissions, higher comorbidity scores and who had TAC in low volume colectomy hospitals had poorer outcomes. Regardless of admission type, outcomes were worse if TAC was performed more than 24 h after admission.

Conclusions

Despite increased hospitalizations for UC, rates of TAC have declined during the post-biologic era. For UC patients who undergo TAC, mortality has declined significantly while morbidity remains stable. Older age, race, emergent admissions and delayed surgery are predictive factors of both postoperative morbidity and mortality.

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Authors and Affiliations

  1. Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA

    Babatunde Olaiya

  2. Department of Gastroenterology, Brooklyn Methodist, New York-Presbyterian Hospital, Brooklyn, NY, USA

    Benjamin D. Renelus

  3. School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Mikolaj Filon

  4. Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Sumona Saha

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Contributions

BO collected and analyzed the data, performed statistical work, drafted and revised the paper. BR, MF, SS participated in discussion, critically reviewed and revised the paper. BO, SS conceptualized and designed the study, and critically revised all the intellectual content of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Babatunde Olaiya.

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Olaiya, B., Renelus, B.D., Filon, M. et al. Trends in Morbidity and Mortality Following Colectomy Among Patients with Ulcerative Colitis in the Biologic Era (2002–2013): A Study Using the National Inpatient Sample. Dig Dis Sci 66, 2032–2041 (2021). https://doi.org/10.1007/s10620-020-06474-1

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