title: Decreasing colectomy rates for ulcerative colitis: a population-based time trend study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada. ggkaplan@ucalgary.ca
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Seow
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.forename: Natalie
authors.initials: N
authors.lastname: Molodecky
authors.forename: Ali
authors.initials: A
authors.lastname: Rezaie
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Moran
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Proulx
authors.forename: James
authors.initials: J
authors.lastname: Hubbard
authors.forename: Anthony
authors.initials: A
authors.lastname: MacLean
authors.forename: Donald
authors.initials: D
authors.lastname: Buie
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D001379:Azathioprine / Q000627:therapeutic use; D003082:Colectomy / Q000706:statistics & numerical data* / Q000639:trends*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine