title: Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome.
abstract: OBJECTIVE
  Approximately 20% of patients undergoing surgery for ulcerative colitis will retain their rectum. A single-stage proctocolectomy could be an appropriate procedure in patients who are definitely not candidates for a later restorative procedure, but it is generally not advised in acutely ill patients. The aim was to investigate the safety of one-stage proctocolectomy under elective and non-elective circumstances, with specific reference to identifying possible risk factors for postoperative complications.
  
  
  METHODS
  A retrospective cohort study, including 54 consecutive patients undergoing proctocolectomy for ulcerative colitis. Out of these, 27 (50%) were admitted non-electively.
  
  
  RESULTS
  Postoperative complications were observed in 30 patients (54%). Wound dehiscence, wound infection, and impaired perineal wound healing were observed in 10 (18.5%), 8 (14.8%), and 10 (18.5%) of the patients, respectively. There was no difference between elective and non-elective cases. Complications were observed more often in patients receiving high-dose corticosteroids (18/26 vs. 12/28; p = 0.06). Impaired perineal wound healing and reoperations were observed more often in the corticosteroid-treated group (8/26 vs. 2/28; p = 0.04 and 12/26 vs. 1/28; p = 0.0003).
  
  
  CONCLUSIONS
  Proctocolectomy is equally safe under elective and non-elective situations, but a preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.
authors.affiliation: Department of Surgery P, University Hospital of Aarhus, Tage Hansensgade, Aarhus C, Denmark.
authors.forename: Rogini
authors.initials: R
authors.lastname: Balachandran
authors.forename: Anders
authors.initials: A
authors.lastname: Tøttrup
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011300:Preoperative Care / Q000009:adverse effects*; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents