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Pediatric Surgery International

Published in:

01-07-2013 | Original Article

Total colectomy for ulcerative colitis in children: when are we operating?

Authors: Jarod P. McAteer, Cindy Larison, Ghassan T. Wahbeh, Matthew P. Kronman, Adam B. Goldin

Published in: Pediatric Surgery International | Issue 7/2013

Abstract

Purpose

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).

Conclusion

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.

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Title: Total colectomy for ulcerative colitis in children: when are we operating?
Authors: Jarod P. McAteer
Cindy Larison
Ghassan T. Wahbeh
Matthew P. Kronman
Adam B. Goldin
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 7/2013
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-013-3307-7

At a glance: The STEP trials

Springer Medicine

Total colectomy for ulcerative colitis in children: when are we operating?

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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