title: Surgical outcomes in steroid refractory acute severe ulcerative colitis: the impact of rescue therapy.
abstract: OBJECTIVE
  The advent of rescue medical therapy (cyclosporin or infliximab) and laparoscopic surgery has shifted the paradigm in managing steroid refractory acute severe ulcerative colitis (ASUC). We investigated prospectively the impact of rescue therapy on timing and postoperative complications of urgent colectomy and subsequent restorative surgery for steroid refractory ASUC.
  
  
  METHODS
  All consecutive presentations of steroid refractory ASUC at the Royal Brisbane Hospital (1996-2009) were entered in the study. Data collated included demographics, clinical and laboratory parameters on admission, medical therapy and operative and postoperative details. Steroid refractory ASUC patients undergoing immediate colectomy were compared with those failing rescue therapy and requiring same admission colectomy.
  
  
  RESULTS
  Of 108 steroid refractory ASUC presentations, 19 (18%) received intravenous steroids only and proceeded directly to colectomy. Rescue medical therapy was instituted in 89 (82%) patients with 30 (34%) failing to respond and proceeding to colectomy. There was no significant difference in the median time from admission to colectomy for rescue therapy compared with steroid-only cases (12 vs 10 days, P = 0.70) or 30-day complication rates (27%vs 47%, P = 0.22). The interval from colectomy to a subsequent restorative procedure was significantly longer for patients who failed rescue therapy (12 vs 5 months, P = 0.02). Furthermore 30-day complications following pouch surgery were significantly higher in patients who failed rescue therapy (32%vs 0%, P = 0.01).
  
  
  CONCLUSIONS
  Rescue therapy in steroid refractory ASUC is not related to delay in urgent colectomy or increased post-colectomy complications.
authors: Colorectal Surgery Gastroenterology Units, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. michaelpowar@me.com
authors: M P
authors: MP
authors: Powar
authors: P
authors: P
authors: Martin
authors: A R
authors: AR
authors: Croft
authors: A
authors: A
authors: Walsh
authors: D
authors: D
authors: Petersen
authors: A R L
authors: AR
authors: Stevenson
authors: J W
authors: JW
authors: Lumley
authors: R W
authors: RW
authors: Stitz
authors: G L
authors: GL
authors: Radford-Smith
authors: D A
authors: DA
authors: Clark
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids