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Incidence Rates and Predictors of Colectomy for Ulcerative Colitis in the Era of Biologics: Results from a Provincial Database

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

We evaluated long-term incidence and identified risk factors of colectomy in pre-biologics and biologics eras for treatment of ulcerative colitis.

Methods

After IRB approval, using data obtained from the Régie d’assurance maladie du Québec, we defined two cohorts: pre-biologics (1998–2004) and biologics (2005–2011) eras. Patients with inflammatory bowel disease or colectomy 1 year prior to first diagnosis of ulcerative colitis were excluded. Multivariate logistic regression model compared patient baseline characteristics. Kaplan-Meier curves displayed unadjusted time to event. Cox proportional hazards models were used to compare adjusted colectomy and mortality rates, respectively.

Results

In pre-biologics and biologics eras, 335/2829 and 314/3313 patients, respectively, underwent colectomy. Median follow-up (first and third quartiles) was similar (p = 0.206). Incidence rates for colectomy were 36.08/1000 and 29.99/1000 patient years. Unadjusted rate of colectomy was higher in pre-biologics era (p = 0.004). Predictors of colectomy included anemia (1.66; 1.38–2.01), gastrointestinal hospitalizations (1.24; 1.04–1.47), congestive heart failure (2.08; 1.27–3.40), and male gender (1.47; 1.26–1.72). Mortality was 8.06 and 3.18% in pre-biologics and biologics eras. After adjusting for potential confounders, age (1.08; 1.05–1.12) and urgent colectomy (5.65; 2.19–14.54) remained associated with increased mortality hazard.

Conclusion

Incidence of colectomy decreased after introduction of biologics. Risk factors for colectomy were gastrointestinal hospitalizations, anemia, male gender, and congestive heart failure. Emergent surgery and age were predictors of mortality.

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Author information

Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada

    Maria Abou Khalil

  2. Department of Surgery, McGill University, Montreal, Quebec, Canada

    Maria Abou Khalil, Marylise Boutros, Nancy Morin, Gabriela Ghitulescu, Carol-Ann Vasilevsky & Philip Gordon

  3. Colorectal Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada

    Marylise Boutros, Nancy Morin, Gabriela Ghitulescu, Carol-Ann Vasilevsky & Philip Gordon

  4. Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

    Hacene Nedjar & Elham Rahme

  5. Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada

    Elham Rahme

  6. Elham Rahme, Center for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd. W Office 3E.12, Montreal, Quebec, H4A 3S5, Canada

    Elham Rahme

Authors
  1. Maria Abou Khalil
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  2. Marylise Boutros
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  4. Nancy Morin
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  5. Gabriela Ghitulescu
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  6. Carol-Ann Vasilevsky
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  7. Philip Gordon
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Contributions

Abou Khalil, M. has substantial contributions to the conception and design of the work; acquisition, analysis, and interpretation of data for the work; is the primary author of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Boutros, M. has substantial contributions to the conception and design of the work, analysis, and interpretation of data for the work and to the drafting of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Hacene, N. has substantial contributions to the analysis of the data; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Morin, N. has substantial contributions to the conception and design of the work and to the drafting of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ghitulescu, G. has substantial contributions to the conception and design of the work and to the drafting of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Vasilevsky, C.A. has substantial contributions to the conception and design of the work and to the drafting of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Gordon, P. has substantial contributions to the conception and design of the work and to the drafting of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Rahme, E. has substantial contributions to the conception and design of the work and acquisition, analysis, and interpretation of data for the work; is the senior author of the work, revised it critically for important intellectual content; will give the final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Elham Rahme.

Additional information

Podium presentation Society for Surgery of the Alimentary Tract (SSAT) annual meeting Digestive Disease Week, May 7, 2017, Presentation #388, Plenary Session: Small Bowel and Colorectal (I) Session; Presentation at SSAT Fellows Research Conference: May 6, 2017.

Appendix

Appendix

Table 4 Colectomy procedure codes used for physician claims in Quebec
Full size table
Table 5 ICD-9 and ICD-10 codes for gastrointestinal hospitalizations
Full size table
Table 6 Definitions of medical comorbidities
Full size table

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Abou Khalil, M., Boutros, M., Nedjar, H. et al. Incidence Rates and Predictors of Colectomy for Ulcerative Colitis in the Era of Biologics: Results from a Provincial Database. J Gastrointest Surg 22, 124–132 (2018). https://doi.org/10.1007/s11605-017-3530-y

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