title: Postoperative complications and mortality following colectomy for ulcerative colitis.
abstract: OBJECTIVE
  Complications after colectomy for ulcerative colitis (UC) have not been well characterized in large, population-based studies. We characterized postoperative in-hospital complications, stratified them by severity, and assessed independent clinical predictors, including use of immunosuppressants.
  
  
  METHODS
  We performed population-based surveillance using administrative databases to identify all adults (≥18 y) who had an International Classification of Diseases-9th/10th revisions code for UC and a colectomy from 1996 to 2009. All medical charts were reviewed. The primary outcome was severe postoperative complications, including in-hospital mortality. Logistic regression was used to assess predictors of complications after colectomy and then restricted to patients undergoing emergent or elective surgeries.
  
  
  RESULTS
  Of the 666 UC patients who underwent a colectomy, a postoperative complication occurred in 27.0% and the mortality rate was 1.5%. Independent predictors of postoperative complications were age (for patients >64 vs 18-34 y: odds ratio [OR], 1.95; 95% confidence interval [CI], 1.07-3.54), comorbidities (>2 vs none: OR, 1.89; 95% CI, 1.06-3.37), and admission status (emergent vs elective colectomy: OR, 1.62; 95% CI, 1.14-2.30). Significant risk factors for an emergent colectomy included time from admission to colectomy (>14 vs 3-14 d: OR, 3.32; 95% CI, 1.62-6.80) and a preoperative complication (≥1 vs 0: OR, 3.04; 95% CI, 1.33-6.91). A prescription of immunosuppressants before colectomies did not increase the risk for postoperative complications.
  
  
  CONCLUSIONS
  Postoperative complications frequently occur after colectomy for UC, predominantly among elderly patients with multiple comorbidities. Patients who were admitted to the hospital under emergency conditions and did not respond to medical treatment had worse outcomes when surgery was performed 14 or more days after admission.
authors.affiliation: Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Shanika
authors.initials: S
authors.lastname: de Silva
authors.forename: Christopher
authors.initials: C
authors.lastname: Ma
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Proulx
authors.forename: Marcelo
authors.initials: M
authors.lastname: Crespin
authors.forename: Belle S
authors.initials: BS
authors.lastname: Kaplan
authors.forename: James
authors.initials: J
authors.lastname: Hubbard
authors.forename: Martin
authors.initials: M
authors.lastname: Prusinkiewicz
authors.forename: Andrew
authors.initials: A
authors.lastname: Fong
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.forename: Paul L
authors.initials: PL
authors.lastname: Beck
authors.forename: Anthony
authors.initials: A
authors.lastname: Maclean
authors.forename: Donald
authors.initials: D
authors.lastname: Buie
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality*; D012307:Risk Factors; D055815:Young Adult