Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications.
BACKGROUND
This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome.


METHODS
All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded.


RESULTS
Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1-22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch-anal anastomosis in 57. During a median follow-up of 5.4 (range 0.5-9.0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0.036).


CONCLUSIONS
Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications.
Randall
J
J
Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK.
Singh
B
B
Warren
B F
BF
Travis
S P L
SP
Mortensen
N J
NJ
George
B D
BD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D016572:Cyclosporine / Q000008:administration & dosage; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D013256:Steroids; D016572:Cyclosporine