Initial surgical management of ulcerative colitis in the biologic era.
BACKGROUND
The initial minimum operation for ulcerative colitis is a total abdominal colectomy. Healthy patients may undergo proctectomy at the same time; however, for ill patients, proctectomy is delayed. Since the introduction of biologic medications in 2005, ulcerative colitis medical management has changed dramatically.


OBJECTIVE
We examined how operative management for ulcerative colitis has changed from the prebiologic to biologic eras.


METHODS
We conducted a retrospective review of data on patients with ulcerative colitis who were included in the Nationwide Inpatient Sample database.


METHODS
This study was conducted at a single university.


METHODS
A total of 1,547,852 patients with ulcerative colitis who were admitted to a US hospital from 1991 to 2011 were included in the study.


METHODS
We examined patients whose initial operation consisted of total abdominal colectomy without proctectomy versus a total proctocolectomy with or without a pouch. We also examined which operation was done at the time of the construction of an ileoanal pouch. Patients who underwent colectomy and pouch construction in the same hospitalization were compared with those who received pouch formation at a subsequent hospitalization.


RESULTS
Ulcerative colitis-related admissions rose by 170% during the years examined, and the number of patients who required total abdominal colectomy increased by 44%. Total abdominal colectomy increased by 15%, as opposed to total proctocolectomy (p < 0.001). Pouch construction at a subsequent operation increased by 16% (p = 0.002). Since 2008, total abdominal colectomy has surpassed total proctocolectomy as the most common initial surgical intervention for ulcerative colitis.


CONCLUSIONS
The Nationwide Inpatient Sample is a retrospective database, and we were limited to examining the variables within it.


CONCLUSIONS
Total abdominal colectomy is currently the most common initial operation for patients with ulcerative colitis, and an ileoanal pouch is more frequently constructed at a subsequent hospitalization. These trends coincide with the initiation of biologic treatments and may imply that patients are acutely ill at the time of initial operation. Alternately, there may be surgeon-perceived bias of increased surgical risk or a shift in care to specialized surgeons for pouch construction.
1Department of Surgery, Oregon Health & Science University, Portland, Oregon 2Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon.
Cristina B
CB
Geltzeiler
Kim C
KC
Lu
Brian S
BS
Diggs
Karen E
KE
Deveney
Kian
K
Keyashian
Daniel O
DO
Herzig
Vassiliki L
VL
Tsikitis
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D039021:Colonic Pouches / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D010359:Patient Readmission / Q000706:statistics & numerical data / Q000639:trends; D016737:Proctocolectomy, Restorative / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D000069285:Infliximab