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01-10-2017 | Original Article

Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes

Authors: Ira L. Leeds, Brindusa Truta, Alyssa M. Parian, Sophia Y. Chen, Jonathan E. Efron, Susan L. Gearhart, Bashar Safar, Sandy H. Fang

Published in: Journal of Gastrointestinal Surgery | Issue 10/2017

Abstract

Background

Timing of surgical intervention for acute ulcerative colitis has not been fully examined during the modern immunotherapy era. Although early surgical intervention is recommended, historical consensus for “early” ranges widely. The purpose of this study was to evaluate outcomes according to timing of urgent surgery for acute ulcerative colitis.

Methods

All non-elective total colectomies in ulcerative colitis patients were identified in the National Inpatient Sample from 2002 to 2014. Procedures, comorbidities, diagnoses, and in-hospital outcomes were collected using International Classification of Disease, 9th Revision codes. An operation was defined as early if within 24 hours of admission. Results were compared between the early versus delayed surgery groups.

Results

We found 69,936 patients that were admitted with ulcerative colitis, and 2650 patients that underwent non-elective total colectomy (3.8%). Early intervention was performed in 20.4% of patients who went to surgery. More early operations were performed laparoscopically (28.1% versus 23.3%, p = 0.021) and on more comorbid patients (Charlson Index, p = 0.008). Median total hospitalization costs were $20,948 with an early operation versus $33,666 with a delayed operation (p < 0.001). Delayed operation was an independent risk for a complication (OR = 1.46, p = 0.001). Increased hospitalization costs in the delayed surgery group were statistically significantly higher with a reported complication (OR = 3.00, p < 0.001) and lengths of stay (OR = 1.26, p < 0.001).

Conclusion

Delayed operations for acute ulcerative colitis are associated with increased postoperative complications, increased lengths of stay, and increased hospital costs. Further prospective studies could demonstrate that this association leads to improved outcomes with immediate surgical intervention for medically refractory ulcerative colitis.

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Title: Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes
Authors: Ira L. Leeds
Brindusa Truta
Alyssa M. Parian
Sophia Y. Chen
Jonathan E. Efron
Susan L. Gearhart
Bashar Safar
Sandy H. Fang
Publication date: 01-10-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3538-3

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Springer Medicine

Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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