Pediatric Surgery International

, Volume 29, Issue 7, pp 689–696 | Cite as

Total colectomy for ulcerative colitis in children: when are we operating?

  • Jarod P. McAteer
  • Cindy Larison
  • Ghassan T. Wahbeh
  • Matthew P. Kronman
  • Adam B. Goldin
Original Article

Abstract

Purpose

Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients.

Methods

We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy.

Results

Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08).

Conclusion

These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.

Keywords

Ulcerative colitis Children Pediatric Colectomy 

Notes

Acknowledgments

The authors have no relevant financial support or conflicts of interest to disclose. There are no funding sources to disclose.

Supplementary material

383_2013_3307_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)
383_2013_3307_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 13 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jarod P. McAteer
    • 1
    • 4
  • Cindy Larison
    • 1
  • Ghassan T. Wahbeh
    • 2
  • Matthew P. Kronman
    • 3
  • Adam B. Goldin
    • 1
  1. 1.Pediatric General and Thoracic SurgerySeattle Children’s Hospital and University of WashingtonSeattleUSA
  2. 2.Pediatric GastroenterologySeattle Children’s Hospital and University of WashingtonSeattleUSA
  3. 3.Pediatric Infectious DiseasesSeattle Children’s Hospital and University of WashingtonSeattleUSA
  4. 4.SeattleUSA

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