title: Total colectomy for ulcerative colitis in children: when are we operating?
abstract: OBJECTIVE
  Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients.
  
  
  METHODS
  We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy.
  
  
  RESULTS
  Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08).
  
  
  CONCLUSIONS
  These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.
authors.affiliation: Pediatric General and Thoracic Surgery, Seattle Children's Hospital and University of Washington, Seattle, WA 98105, USA. jarodmc@uw.edu
authors.forename: Jarod P
authors.initials: JP
authors.lastname: McAteer
authors.forename: Cindy
authors.initials: C
authors.lastname: Larison
authors.forename: Ghassan T
authors.initials: GT
authors.lastname: Wahbeh
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kronman
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones; D000740:Anemia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003015:Clostridium Infections / Q000150:complications; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D016208:Databases, Factual / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000150:complications; D016017:Odds Ratio; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014882:Water-Electrolyte Balance
chemical_list: D000305:Adrenal Cortex Hormones