Semi-urgent surgery in hospitalized patients with severe ulcerative colitis does not increase overall J-pouch complications

Caitlin Hicks, Richard A. Hodin, Liliana Bordeianou

Research output: Contribution to journalArticle

Abstract

Background Surgeons frequently discourage patients with ulcerative colitis from having surgery in the midst of an acute flare for fear of complications and poor long-term outcomes. Methods Outcomes of patients undergoing urgent versus elective surgery for ulcerative colitis were compared via retrospective review. Results Patients undergoing urgent (n = 80) versus elective (n = 99) surgery were younger, were more malnourished, had more severe active disease, and had higher steroid use (P ≤.05). During surgery, hemodynamic stability was similar, but urgent patients underwent more subtotal colectomies (5.1% vs 29%, P <.0001) and fewer laparoscopic procedures (8.8% vs 18%, P =.07). Multivariate regression suggested that short-term complications were increased with higher body mass index and urgency status (P ≤.05). Anastomotic leaks and long-term complications were similar between groups. Surgeon inexperience and use of immunomodulators other than infliximab were associated with increased odds of long-term fistula/abscess (odds ratio, 5.56; P =.05] and pouch failure (odds ratio, 13.3; P =.01). Conclusions Surgery in patients with acute ulcerative colitis flares is associated with more short-term complications than elective procedures but does not appear to affect risk for anastomotic leak or long-term complications when performed by an expert.

Original languageEnglish (US)
Pages (from-to)281-287
Number of pages7
JournalAmerican Journal of Surgery
Volume207
Issue number2
DOIs
StatePublished - Feb 1 2014

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Colonic Pouches
Ulcerative Colitis
Anastomotic Leak
Odds Ratio
Colectomy
Immunologic Factors
Abscess
Fistula
Fear
Body Mass Index
Hemodynamics
Steroids

Keywords

  • Complications of IBD
  • Surgery for IBD
  • Ulcerative colitis

ASJC Scopus subject areas

  • Surgery

Cite this

Semi-urgent surgery in hospitalized patients with severe ulcerative colitis does not increase overall J-pouch complications. / Hicks, Caitlin; Hodin, Richard A.; Bordeianou, Liliana.

In: American Journal of Surgery, Vol. 207, No. 2, 01.02.2014, p. 281-287.

Research output: Contribution to journalArticle

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N2 - Background Surgeons frequently discourage patients with ulcerative colitis from having surgery in the midst of an acute flare for fear of complications and poor long-term outcomes. Methods Outcomes of patients undergoing urgent versus elective surgery for ulcerative colitis were compared via retrospective review. Results Patients undergoing urgent (n = 80) versus elective (n = 99) surgery were younger, were more malnourished, had more severe active disease, and had higher steroid use (P ≤.05). During surgery, hemodynamic stability was similar, but urgent patients underwent more subtotal colectomies (5.1% vs 29%, P <.0001) and fewer laparoscopic procedures (8.8% vs 18%, P =.07). Multivariate regression suggested that short-term complications were increased with higher body mass index and urgency status (P ≤.05). Anastomotic leaks and long-term complications were similar between groups. Surgeon inexperience and use of immunomodulators other than infliximab were associated with increased odds of long-term fistula/abscess (odds ratio, 5.56; P =.05] and pouch failure (odds ratio, 13.3; P =.01). Conclusions Surgery in patients with acute ulcerative colitis flares is associated with more short-term complications than elective procedures but does not appear to affect risk for anastomotic leak or long-term complications when performed by an expert.

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