title: Prolonged Medical Therapy Increases the Risk of Surgical Complications in Patients with Severe Ulcerative Colitis.
abstract: OBJECTIVE
  To determine the risk factors of surgical complications and the optimal timing of surgery for patients with severe ulcerative colitis (UC).
  
  
  METHODS
  One hundred one UC patients who had undergone surgery for a severe indication were retrospectively reviewed. Indications included severe disease unresponsive to medical therapy, massive bleeding, toxic megacolon, and colon perforation. Outcomes were compared based on the occurrence or absence of surgical complications. Patients with severe disease unresponsive to medical therapy were investigated separately to determine the optimal timing of surgery.
  
  
  RESULTS
  There was no significant difference regarding the use of rescue therapy. The duration of all medical therapy for a severe attack was the only significant factor associated with a surgical complication (p = 0.032). In patients with severe disease unresponsive to medical therapy, the receiver operating characteristic curve analysis showed that 30.5 days was the length of medical therapy after which the risk of surgical complications significantly increased.
  
  
  CONCLUSIONS
  In patients with severe UC, rescue therapy itself was not related to an increased risk of surgical complications. However, prolonged medical therapy increased the risk of surgical complications. Patients should undergo surgery within 30 days from the institution of medical therapy for a severe attack.
authors: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
authors: Hideaki
authors: H
authors: Kimura
authors: Reiko
authors: R
authors: Kunisaki
authors: Kenji
authors: K
authors: Tatsumi
authors: Kazutaka
authors: K
authors: Koganei
authors: Akira
authors: A
authors: Sugita
authors: Itaru
authors: I
authors: Endo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D008532:Megacolon, Toxic / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D000067251:Symptom Flare Up; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult