P18 Colectomy rates in ulcerative colitis: a systematic review and meta-analysis

Abstract

<h3>Introduction</h3> Surgical management in UC is almost exclusively utilised in medically refractory cases and is therefore a useful marker for the efficacy of medical management. Our aim was to understand the prevalence of colectomy in UC and how this has changed over time. <h3>Methods</h3> A systematic search of the medical literature was conducted using MEDLINE (1946 to May 2021), EMBASE and EMBASE classic (1947 to May 2021) to identify all studies with a population of n&gt;500 that reported colectomy rates in patients &gt;18 years of age with UC. The primary outcome was the prevalence of colectomy at 1, 5 and 10 years after diagnosis. A secondary outcome was that of colectomy rates at 2, 15 and 20 years and in the pre-biologics (defined as pre-2004) compared to post-biologics eras (defined as post-2004). <h3>Results</h3> 31 papers with a combined 294,359 patients with UC were included for review and meta-analysis. The prevalence of colectomy at 1, 2, 5, 10, 15 and 20-years post-diagnosis were 3%, 3%, 5%, 10%, 10%, 14% respectively. The pooled relative risk for colectomy in the post-biologics era was 0.68 (95% CI 0.42 to 1.09) at 1-year post-diagnosis and 0.71 (95% CI 0.56 to 0.91) at 5-years post-diagnosis. <h3>Conclusions</h3> The overall colectomy rate has decreased over the past five decades. Biologics appear to reduce the risk of colectomy, but the relative risk reduction is modest and other treatment factors and improved care are likely to have contributed to this reduction.