Decreasing Colectomy Rates for Ulcerative Colitis: A Population-Based Time Trend Study

1] Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta [2] Division of Gastroenterology, University of Calgary, Calgary, Alberta [3] Department of Medicine, University of Calgary, Calgary, Alberta [4] Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
The American Journal of Gastroenterology (Impact Factor: 10.76). 11/2012; 107(12). DOI: 10.1038/ajg.2012.333
Source: PubMed


Colectomy rates for ulcerative colitis (UC) have been inconsistently reported. We assessed temporal trends of colectomy rates for UC, stratified by emergent vs. elective colectomy indication.

From 1997 to 2009, we identified adults hospitalized for a flare of UC. Medical charts were reviewed. Temporal changes were evaluated using linear regression models to estimate the average annual percent change (AAPC) in surgical rates. Logistic regression analysis compared: (i) UC patients responding to medical management in hospital to those who underwent colectomy; (ii) UC patients who underwent an emergent vs. elective colectomy; and (iii) temporal trends of drug utilization.

From 1997 to 2009, colectomy rates significantly dropped for elective colectomies with an AAPC of -7.4% (95% confidence interval (CI): -10.8%, -3.9%). The rate of emergent colectomies remained stable with an AAPC of -1.4% (95% CI: -4.8%, 2.0%). Azathioprine/6-mercaptopurine prescriptions increased from 1997 to 2009 (odds ratio (OR)=1.15; 95% CI: 1.09-1.22) and infliximab use increased after 2005 (OR=1.68; 95% CI: 1.25-2.26). A 13% per year risk adjusted reduction in the odds of colectomy (OR=0.87; 95% CI: 0.83-0.92) was observed in UC patients responding to medical management compared with those who required colectomy. Emergent colectomy patients had a shorter duration of flare (<2 weeks vs. 2-8 weeks, OR=5.31; 95% CI: 1.58-17.81) and underwent colectomy early after diagnosis (<1 year vs. 1-3 years, OR=5.48; 95% CI: 2.18-13.79).

From 1997 to 2009, use of purine anti-metabolites increased and elective colectomy rates in UC patients decreased significantly. In contrast, emergent colectomy rates were stable, which may have been due to rapid progression of disease activity.

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    • "Although emergency colectomy rates, accounting for approximately 50% of the colectomies performed for UC, seem to remain stable [27], studies have indicated that the overall colectomy rate has declined over the years. In the Copenhagen cohort, Langholz et al found that the 1-year colectomy rate for UC patients from 1962-87 was 9% [28], whereas Vind et al found, using the same methodology, a some what lower 1-year colectomy rate of 6% from 2003-2005 [29]. "
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    ABSTRACT: The clinical course of ulcerative colitis (UC) may range from a quiescent course with prolonged periods of remission to fulminant disease requiring intensive medical treatment or surgery. Disease outcome is often determined by relapse rates, the development of colorectal cancer (CRC) and mortality rates. Early patient classification, identifying those with a high risk of developing complicated disease, is essential for choosing appropriate treatment. This paper reviews the clinical outcomes of UC patients as reported in population-based and observational studies representative of the whole patient population. Extensive colitis, a high level of systemic symptoms and young age at diagnosis are factors associated with a high risk of colectomy. Patients with distal disease who progress to extensive colitis seem to be a subgroup with an especially high risk of colectomy. Some prognostic factors of severe disease have been identified which could be used to optimize treatment and possibly reduce future complications. The overall risk of CRC and mortality was not significantly different from that of the background population. These results may have implications for follow-up strategies, especially regarding endoscopic surveillance of UC patients.
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