Risk Factors for Ulcerative Colitis (UC) Surgery in a Population-Based Cohort

Abstract

Purpose: We sought to identify clinical and demographic features influencing initial and subsequent surgery in a population-based cohort of UC. Methods: Medical records of Olmsted County residents diagnosed with UC from 1970–2001 were reviewed to identify all surgeries. Colectomies were classified as: total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA), subtotal colectomy (SC) with ileostomy, TPC-ileostomy, and partial colectomy (PC). Planned 2nd-stage surgeries were excluded in counting unplanned follow-up surgeries. Cumulative incidences of initial colectomy from time of diagnosis (dx) and follow-up surgeries from time of colectomy were estimated actuarially. Proportional hazards regression was used to assess association of clinical/demographic features with time to colectomy and time to follow-up surgery (after colectomy). Results: 316 UC pts (57% males) were followed for 3,698 person-yrs. Fifty-three pts (17%) had a surgery for UC, of whom 37 (70%) underwent >1 procedure. See table for cumulative risks of initial colectomy and selected subtypes. Males were more likely to undergo colectomy (hazards ratio[HR], 2.2; 95% CI, 1.1–4.1). Extensive UC was not significantly associated with colectomy (HR, 1.4;95% CI, 0.7–2.6) relative to proctitis/left-sided UC. Use of steroids within 90 days of UC dx was strongly associated with colectomy (HR, 3.2; 95% CI, 1.6–6.5). Initial colectomy subtypes were: TPC-IPAA (62%), SC (6%), TPC-ileostomy (30%), and PC (2%). Second colectomy-related surgeries were common, including ostomy closure in 60%; this varied by colectomy type. The 10-yr cumulative risk of subsequent unplanned surgery was 44.1% overall and varied by colectomy type (see table). Those undergoing TPC-IPAA compared to TPC-ileostomy were 1.9 times more likely to have unplanned follow-up surgeries, but this difference was not significant(95% CI, 0.6–5.9). Conclusion: In this population-based cohort of UC pts, the 20-yr cumulative incidence of colectomy was ∼ 20%. Male gender and early need for corticosteroids were significantly associated with colectomy. The most common surgeries were TPC-IPAA and TPC-ileostomy, and frequent unplanned surgeries post-colectomy were observed.Table: Cumulative Risks