Does aggressive medical therapy for acute ulcerative colitis result in a higher incidence of staged colectomy?
BACKGROUND
Colectomy with ileal pouch-anal anastomosis is the operation of choice in patients with medically refractory ulcerative colitis. However, aggressive or prolonged medical treatment may result in the patient's needing an urgent operation in which a staged subtotal colectomy is necessary.


OBJECTIVE
Our hypothesis is that the incidence of patients requiring a staged approach has increased, along with an increase in hospital stay and total hospital costs.


METHODS
We examined the medical records of 250 consecutive patients with ulcerative colitis who underwent ileal pouch-anal anastomosis between 1984 and 1993.


RESULTS
Simultaneous colectomy and ileal pouch-anal anastomosis were performed in 196 patients (78%), while 54 patients (21.6%) required staged subtotal (78%) or partial colectomy (22%). Indications for initial colectomy included failure of medical therapy (42 patients [77.8%]), undifferentiated colitis (five patients [9.3%]), and perforation (six patients [11.1%]). An increase in the incidence of patients requiring staged colectomy during this period was observed (P < .05). Staged procedures led to a prolonged hospital course at a significantly greater total cost.


CONCLUSIONS
We conclude that aggressive medical therapy of acute ulcerative colitis has increased the incidence of urgent staged colectomy with a resulting increase in morbidity, hospital stay, and cost and a less-optimal functional result.
Ferzoco
S J
SJ
Division of General and Gastrointestinal Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
Becker
J M
JM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007081:Ileostomy / Q000379:methods; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008531:Megacolon / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods; D012007:Rectum / Q000601:surgery; D012460:Sulfasalazine / Q000627:therapeutic use; D017211:Treatment Failure
D005938:Glucocorticoids; D012460:Sulfasalazine