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



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.


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.


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).


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.


Ulcerative colitis Children Pediatric Colectomy 



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

Supplementary material

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


  1. 1.
    Park KT, Bass D (2011) Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States: a review. Inflamm Bowel Dis 17:1603–1609PubMedCrossRefGoogle Scholar
  2. 2.
    Griffiths AM (2004) Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin Gastroenterol 18:509–523PubMedCrossRefGoogle Scholar
  3. 3.
    Levine A (2009) Pediatric inflammatory bowel disease: is it different? Dig Dis 27:212–214PubMedCrossRefGoogle Scholar
  4. 4.
    Turner D, Griffiths AM (2011) Acute severe ulcerative colitis in children: a systematic review. Inflamm Bowel Dis 17:440–449PubMedCrossRefGoogle Scholar
  5. 5.
    Leijonmarck CE, Persson PG, Hellers G (1990) Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study. Gut 31:329–333PubMedCrossRefGoogle Scholar
  6. 6.
    Hoie O, Wolters FL, Riis L et al (2007) Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years. Gastroenterology 132:507–515PubMedCrossRefGoogle Scholar
  7. 7.
    Turner D, Walsh CM, Benchimol EI et al (2008) Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy. Gut 57:331–338PubMedCrossRefGoogle Scholar
  8. 8.
    Turner D, Mack D, Leleiko N et al (2010) Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response. Gastroenterology 138:2282–2291PubMedCrossRefGoogle Scholar
  9. 9.
    Turner D, Otley AR, Mack D et al (2007) Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology 133:423–432PubMedCrossRefGoogle Scholar
  10. 10.
    Ananthakrishnan AN, Issa M, Beaulieu DB et al (2009) History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis. Inflamm Bowel Dis 15:176–181PubMedCrossRefGoogle Scholar
  11. 11.
    Ananthakrishnan AN, McGinley EL, Binion DG et al (2010) Simple score to identify colectomy risk in ulcerative colitis hospitalizations. Inflamm Bowel Dis 16:1532–1540PubMedCrossRefGoogle Scholar
  12. 12.
    Gower-Rousseau C, Dauchet L, Vernier-Massouille G et al (2009) The natural history of pediatric ulcerative colitis: a population-based cohort study. Am J Gastroenterol 104:2080–2088PubMedCrossRefGoogle Scholar
  13. 13.
    Allison J, Herrinton LJ, Liu L et al (2008) Natural history of severe ulcerative colitis in a community-based health plan. Clin Gastroenterol Hepatol 6:999–1003PubMedCrossRefGoogle Scholar
  14. 14.
    Guthery SL, Dong L, Dean JM et al (2008) US estimates of hospitalized pediatric patients with ulcerative colitis: implications for multicenter clinical studies. Inflamm Bowel Dis 14:1253–1258PubMedCrossRefGoogle Scholar
  15. 15.
    Turunen P, Ashorn M, Auvinen A et al (2009) Long-term health outcomes in pediatric inflammatory bowel disease: a population-based study. Inflamm Bowel Dis 15:56–62PubMedCrossRefGoogle Scholar
  16. 16.
    Bradley GM, Oliva-Hemker M (2012) Pediatric ulcerative colitis: current treatment approaches including role of infliximab. Biologics 6:125–134PubMedGoogle Scholar
  17. 17.
    Turner D, Travis SP, Griffiths AM et al (2011) Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN. Am J Gastroenterol 106:574–588PubMedCrossRefGoogle Scholar
  18. 18.
    Kelley-Quon LI, Jen HC, Ziring DA et al (2012) Predictors of proctocolectomy in children with ulcerative colitis. J Pediatr Gastroenterol Nutr 55(5):534–540PubMedCrossRefGoogle Scholar
  19. 19.
    Farkas K, Nagy F, Szepes Z et al (2011) Risk factors for colectomy in ulcerative colitis patients with severe flare-up: some of the few things comparable between the US and Central Europe. Inflamm Bowel Dis 17:E11–E12PubMedCrossRefGoogle Scholar
  20. 20.
    Moore JC, Thompson K, Lafleur B et al (2011) Clinical variables as prognostic tools in pediatric-onset ulcerative colitis: a retrospective cohort study. Inflamm Bowel Dis 17:15–21PubMedCrossRefGoogle Scholar
  21. 21.
    Shiga H, Takagi S, Inoue R et al (2010) What determines the later clinical course of patients who do not undergo colectomy at the first attack? A Japanese cohort study on ulcerative colitis. Digestion 81:104–112PubMedCrossRefGoogle Scholar
  22. 22.
    Issa M, Ananthakrishnan AN, Binion DG (2008) Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis 14:1432–1442PubMedCrossRefGoogle Scholar
  23. 23.
    Park KT, Tsai R, Perez F et al (2012) Cost-effectiveness of early colectomy with ileal pouch-anal anastomosis versus standard medical therapy in severe ulcerative colitis. Ann Surg 256(1):117–124PubMedCrossRefGoogle Scholar
  24. 24.
    Pakarinen MP, Natunen J, Ashorn M et al (2009) Long-term outcomes of restorative proctocolectomy in children with ulcerative colitis. Pediatrics 123:1377–1382PubMedCrossRefGoogle Scholar

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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