Colectomy Rates For Ulcerative Colitis Research Articles

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Colectomy rates in ulcerative colitis: A systematic review and meta-analysis.

Surgical management in Ulcerative Colitis (UC) is typically utilised in medically refractory cases and, therefore, it is a useful marker for efficacy of medical management. To understand the changing prevalence of colectomy in UC over time. A systematic review was conducted using MEDLINE (1946-2021), EMBASE and EMBASE classic (1947-2021) to identify studies with a population of n>500 that reported colectomy rates in UC patients >18 years old. The primary outcome was the prevalence of colectomy at 1-, 5- and 10-years post-diagnosis. Secondary outcomes included colectomy rates in the pre-biologics (defined as pre-2004) and post-biologics eras (defined as post-2004). Thirty-one studies with 294,359 patients with UC were included for review and meta-analysis. The prevalence of colectomy at 1-, 5- and 10-years post-diagnosis were 3% (95% CI 2%-6%), 5% (95% CI 2%-9%), 10% (95% CI 6%-16%) respectively. The pooled relative risk for colectomy in the post-biologics era was 0.68 (95% CI 0.42 to 1.09, p=0.10) at 1-year and 0.71 (95% CI 0.56 to 0.91, p<0.01) at 5-years post-diagnosis. The overall colectomy rate has decreased over the past three decades. Biologics may have played a role in reducing the risk of colectomy, however the relative risk reduction is likely to be modest.

Colectomy rates for ulcerative colitis over time: Navigating the evidence in the era of precision medicine and individualised treatment

Nick Dai and colleagues [1] conducted an up-to-date review of the literature to assess the rates of colectomy for ulcerative colitis (UC) over time, also comparing the pre-biologic vs biologic drug eras. Indeed many clinicians and their patients hoped that biologics would reduce, or even eliminate, the need for surgery,1 and whilst a reduction in colectomy rates occurred, the effect is smaller than expected.

S186 Variation in Colectomy Rates in Ulcerative Colitis

S186 Variation in Colectomy Rates in Ulcerative Colitis

P489 Temporal trends of colectomy for ulcerative colitis in the multi-drug era; a population based cohort study

Abstract Background We are now in the multi-drug era for ulcerative colitis (UC). The use of advanced therapies for UC has dramatically increased over the last 6 years. NICE approvals of anti-TNF and anti-α4β7 therapy (both in 2015) were followed by IL12/23 (2019) and janus kinase inhibitors (2020). The aim of this study was to describe the impact of this change in patterns of advanced therapy prescribing on colectomy rates for UC within a well defined population-based cohort. Methods The Lothian IBD registry (LIBDR) is a manually validated, prevalent dataset compiled through capture-recapture methodology (Jones et al. 2018) that is &amp;gt;95% complete for the 907,580 residents of NHS Lothian (mid-2019 population estimates). The LIBDR contains measured prevalence between 2008–2018, estimated prevalence from 2018–2028 (derived from Autoregressive integrated moving average {ARIMA} modelling). All patients with a diagnosis of UC who underwent a colectomy in Lothian, Scotland between 01/01/2005 and 31/102021 were identified by interrogating multiple clinical and administrative databases. Linear and segmental regression analyses were used to identify the annual percentage change (APC) and temporal trends (statistical joinpoints) in colectomy rates. Results 485 patients underwent colectomy for UC between 2005 and October 2021 (Fig 1). Colectomy rates per 100 UC patients fell from 1.47 colectomies in 2005 to 0.25 in 2021 (p=0.009). The colectomy APC decreased by 4.1% per year between 2005 and 2014 and 18.5% per year between 2014 and 2021 (Figure 2). Temporal trend analysis (2005–2021) identified a significant joinpoint in colectomy rates in 2014 (p=0.009) (Figure 2). Figure 1 Absolute number of colectomies for UC per year between 2005–2021. Linear regression showing colectomy numbers (solid line) and 95% confidence intervals (dashed lines) constrained at 2014. Figure 2, Colectomy rates per 100 UC patients from 2005–2021. Joinpoint regression separated at inflection point at 2014 (solid line). Between 2005 and 2007, 0 / 100 patients undergoing colectomy received maintenance biologic treatment prior to the admission for colectomy. Between 2019 and 2021, 19 / 33 (57.8%) patients received maintenance biologic therapy prior to colectomy (Figure 3). Figure 3. Percentage of colectomy patients who had been treated with at least 1 maintenance biologic prior to surgery. Conclusion This population based cohort study has shown a significant reduction in the rate of colectomy for UC that has coincided with the introduction of biologic medication. Whilst we cannot ascribe causality, within this study the timeline of falling colectomy rates closely parallels the rapid increase in the use of biologic medication.

Colectomy rate in ulcerative colitis 15 years after diagnosis: Results from the 2001-2003 Navarra cohort

Knowing the natural history of ulcerative colitis (UC) is essential to understand the course of the disease, assess the impact of different treatment strategies and identify poor prognostic factors. One of the most significant matters in this regard is the need for surgery. To analyse the Colectomy Incidence Rate (CIR) from diagnosis to end of follow-up (31/12/2017) and identify predictive factors for colectomy. A retrospective study enrolling patients with a definitive diagnosis (DD) of UC or Unclassified Colitis (UnC) in the 2001−03 Navarra cohort. We enrolled 174 patients with a DD of UC (E2 42.8%; E3 26.6%) and 5 patients with a DD of UnC: 44.1% women, median age 39.2 years (range 7–88) and median follow-up 15.7 years. A total of 8 patients underwent surgery (CIR 3 colectomies/103 patient-years: 3 at initial diagnosis (<1 month), 2 in the first 2 years, 2 at 5 years from diagnosis and 1 at 12 years from diagnosis. All had previously received steroids; 5 had received immunomodulators and 2 had received biologics. In 7 patients (87%), surgery was performed on an emergency basis. The indication was megacolon in 3 (37.5%), severe flare-up in 3 (37.5%) and medical treatment failure in 2 (25%). In 5 cases (62.5%), an ileoanal pouch was made, and in 3 cases, a definitive ileostomy was performed. In the univariate analysis, patients with loss of more than 5 kg at diagnosis and admission at diagnosis had a lower rate of colectomy-free survival. In our series, colectomy rates are lower than usually reported. Most colectomies were performed in the first 5 years following diagnosis and had an emergency indication. Conocer la historia natural de la colitis ulcerosa (CU) es esencial para entender la evolución de la enfermedad, evaluar el impacto de las distintas estrategias terapéuticas e identificar factores de mal pronóstico. Uno de los aspectos más relevantes, en este sentido, es la necesidad de cirugía. Analizar la Tasa de Incidencia de Colectomía (TIC) desde el diagnóstico hasta el fin de seguimiento (31-12-2017) e identificar factores predictivos de colectomía. Estudio retrospectivo que incluye los pacientes con diagnóstico definitivo (DD) de CU o Colitis Inclasificable (CI) en la cohorte Navarra 2001−03. Incluimos 174 pacientes con DD de CU (E2 42,8%–E3 26,6%) y 5 de CI: 44,1% mujeres, mediana edad 39,2 años (rango 7–88), mediana de seguimiento 15,7 años. Se intervienen 8 pacientes (TIC 3 colectomías/10 3 pac/a): 3 al debut (<1 mes), 2 en los primeros 2 años, 2 a los 5 años y 1 a los 12 años de evolución. Todos habían recibido esteroides, 5 inmunomoduladores y 2 biológicos. En 7 (87%) la cirugía fue urgente y la indicación, megacolon en 3 (37,5%), brote grave en 3 (37’5%) y fallo a tratamiento médico en 2 (25%). En 5 casos (62,5%) se realizó un reservorio ileoanal y en 3 ileostomía definitiva. En el análisis univariante los pacientes con pérdida >5 kg e ingreso al debut presentaron una menor supervivencia libre de colectomía. En nuestra serie, las tasas de colectomía son más bajas que las comunicadas habitualmente, mayoritariamente se realizan en los primeros 5 años de evolución y se indican con carácter urgente.

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient.

Despite significant development in the pharmacological treatment of inflammatory bowel diseases (IBD) along with the evolution of therapeutic targets and treatment strategies, a significant subset of patients still requires surgery during the course of the disease. As IBD patients are frequently exposed to biologics at the time of abdominal and perianal surgery, it is crucial to identify any potential impact of biological agents in the perioperative period. Even though detectable serum concentrations of biologics do not seem to increase postoperative complications after abdominal procedures in IBD, there is increasing evidence on the role of therapeutic drug monitoring (TDM) in the perioperative setting. This review aims to provide a comprehensive summary of published studies reporting the association of drug concentrations and postoperative outcomes, postoperative recurrence (POR) after an ileocolonic resection for Crohn’s disease (CD), colectomy rates in ulcerative colitis (UC), and perianal fistulizing CD outcomes in patients treated with biologics. Current data suggest that serum concentrations of biologics are not associated with an increased risk in postoperative complications following abdominal procedures in IBD. Moreover, higher concentrations of anti-TNF agents are associated with a reduction in colectomy rates in UC. Finally, higher serum drug concentrations are associated with reduced rates of POR after ileocolonic resections and increased rates of perianal fistula healing in CD. TDM is being increasingly used to guide clinical decision making with favorable outcomes in many clinical scenarios. However, given the lack of high quality data deriving mostly from retrospective studies, the evidence supporting the systematic application of TDM in the perioperative setting is still inconclusive.

Early thiopurine maintenance is associated with reduced proximal disease progression and colectomy rate in ulcerative colitis.

Thiopurines effectively maintain remission in ulcerative colitis patients. Whether early initiation of thiopurines after ulcerative colitis diagnosis decreases proximal disease progression and colectomy rates is not known. We conducted a cohort study of ulcerative colitis subjects recruited from 1970 to 2009. Early thiopurine maintenance was defined as commencement of azathioprine or mercaptopurine within 5 years of diagnosis and maintenance for at least 6 months. Propensity score matching was conducted to correct for confounders influencing early thiopurine introduction. Outcomes of interest were colectomy rate and endoscopic proximal disease extension. 982 consecutive ulcerative colitis subjects (12 879 patient-years) were recruited with 116 requiring colectomy. Thiopurines initiation and maintenance increased over time with median time to thiopurine commencement decreasing from 23 years in the first decade to 2 years in the last decade (P < 0.0001). Multivariate analysis showed that early thiopurine maintenance significantly decreased the need for colectomy [hazard ratio, 0.13; 95% confidence interval (CI):0.03-0.55; P = 0.006]. The number of subjects needed to be treated to reduce one colectomy at 5 and 10 years was 18 (95% CI, 16- 36) and 12 (95% CI, 11-25). After propensity score matching, early thiopurine maintenance was significantly associated with decreased colectomy (hazard ratio, 0.10; 95% CI, 0.03-0.43; P = 0.002) and proximal progression of disease extent (hazard ratio, 0.26; 95% CI, 0.10-0.78; P = 0.015). Early thiopurine maintenance for >6 months is significantly associated with reduced colectomy and proximal progression of disease extent in ulcerative colitis.

Analysis of colectomy rates for ulcerative colitis in pre- and postbiological eras in Lothian, Scotland.

Biological treatment is effective in maintaining remission in ulcerative colitis (UC), although the effect on colectomy rates remains unclear. In the UK the use of antitumour necrosis factor and anti-α4β7 treatments for maintenance therapy in UC was restricted until 2015. The aim of this study was to describe the impact that this change in the prescribing of biologicals had on colectomy rates for UC. All patients (adult and paediatric) with a diagnosis of UC who received maintenance biological treatment and/or underwent a colectomy in Lothian, Scotland between 2005 and 2018 were identified. Linear and segmental regression analyses were used to identify the annual percentage change (APC) and temporal trends (statistical joinpoints) in biological prescription and colectomy rates. Rates of initiation of maintenance biological therapy increased from 0.05 per 100 UC patients in 2005 to 1.26 in 2018 (p<0.001). Colectomy rates per 100 UC patients fell from 1.47 colectomies in 2005 to 0.44 in 2018 (p<0.001). The APC for colectomy decreased by 4.1% per year between 2005 and 2014 and by 18.9% between 2014 and 2018. Temporal trend analysis (2005-2018) identified a significant joinpoint in colectomy rates in 2014 (p=0.019). The use of maintenance biological therapy increased sharply following the change in guidance. This has been paralleled by a significant reduction in the rates of colectomy over the same time period.

Evaluation of a U.S. National Cohort to Determine Utilization in Colectomy Rates for Ulcerative Colitis Among Ethnicities.

Colectomy is the curative management for ulcerative colitis (UC). Multiple studies have reported racial disparities for colectomy before the advent of anti-TNF alpha agents. The aim of this study was to describe racial and geographic differences in colectomy rates among hospitalized patients with UC after anti-TNF therapy was introduced. We examined all patients discharged from the hospital between 2010 and 2014 with a primary diagnosis of UC or of complications of UC. The data were evaluated for race and colectomy rates among the hospitalized patients with UC. The unadjusted national colectomy rate among hospitalized patients with UC between 2010 and 2014 was 3.90 per 1000 hospitalization days (95% confidence interval, 3.72-4.08). The undajusted colectomy rates in African American (2.33 vs 4.35; P < 0.001) and Hispanic patients (3.99 vs 4.35; P ≤ 0.009) were considerably lower than those for White patients. After adjustment for confounders, the incidence rate ratio for African American as compared to White patients was 0.43 (95% confidence interval, 0.32-0.58; P < 0.001). Geographic region of the United States also showed significant variation in colectomy rates, with western regions having the highest rate (4.76 vs 3.20; P < 0.001). Racial and geographical disparities persist for the rate of colectomy among hospitalized patients with UC. The national database analysis reveals that colectomy rates for hospitalized African American and Hispanic patients were lower than those for White patients. Further studies are important to determine the social and biologic foundations of these disparities.

Colectomy rates for ulcerative colitis in England 2003-2016.

Temporal trends in colectomy rate for ulcerative colitis (UC) are particularly relevant in the current era of published IBD standards and changing approach to salvage of acute severe disease. To investigate temporal trends in colectomy for UC using English population data. The Hospital Episode Statistics (HES) were interrogated between 2003-2016 with two patient groups investigated independently. An 'emergency' cohort: emergency UC admission≥three days, age ≥18 and a 'total population' cohort: all English patients undergoing colectomy for UC. Mixed methods analyses were utilised. Emergency cohort: 37981 patients, 49% female, median age 46. The one- and three-year incidence of colectomy after acute admission was 0.17 and 0.21. Interrupted time series (ITS) analysis suggested reductions in colectomy rate of 4% per year after 2008 at 30 and 90days following emergency admission, with no significant reduction ≥1year. Mortality and laparoscopy rates improved when avoiding colectomy at index and emergency admissions; however, the proportion of emergency colectomies after salvage at index admission significantly increased during the study period. Total population cohort: 17580 patients underwent colectomy for UC between 2003 and 2016, demonstrating a 3.1% annual reduction in total and elective colectomies after 2008, but no reduction in emergency colectomies. Reductions in short-term colectomy rates after emergency admission for UC do not persist beyond one year. Emergency colectomy rates remain unchanged. Reduced rates are probably due to multi-modal improvements in IBD care. A lack of data regarding disease severity precludes further interpretation of appropriate medical salvage and timely surgery.

Tacrolimus induces short-term but not long-term clinical response in inflammatory bowel disease.

Tacrolimus is a calcineurin inhibitor commonly used for prophylaxis of rejection in renal and liver transplantation. There are limited but favourable data regarding its possible use in patients with inflammatory bowel disease (IBD). To evaluate the efficacy and safety of tacrolimus in patients with IBD in clinical practice. We performed a retrospective, multicentre study in 22 centres in Spain. All adult patients who received oral tacrolimus for luminal or perianal IBD were included. Clinical response was assessed by Harvey-Bradshaw index and partial Mayo score after 3months. Perianal disease was evaluated by fistula drainage assessment. One hundred and forty-three patients were included (mean age 38years; 51% male; median disease duration 110months). In ulcerative colitis (UC) (n=58), the partial Mayo score decreased after 3months from median 6 to 3 (P=0.0001), whereas in Crohn's disease (CD) (n=85), the Harvey-Bradshaw index decreased after 3months from median 9 to 7 (P=0.011). In CD patients, blood tacrolimus concentrations during induction (>10ng/mL vs <10ng/mL; odds ratio 0.23, 95% CI 0.05-0.87) and the concomitant use of thiopurines (odds ratio 0.18, 95% CI 0.04-0.81) were associated with lower clinical disease activity at 3months. Of 62 patients with perianal disease, complete closure was observed in 8% (n=5) of patients with perianal fistulas, with 34% (n=21) showing partial response. Treatment was maintained for a median of 6months (IQR, 2-16). After a median clinical follow-up of 24months (IQR, 15-57), the rate of treatment-related adverse events was 34%, correlating with blood drug concentrations (P=0.021). Finally, 120 patients (84%) discontinued tacrolimus, usually due to absence or loss of response. Three patients (2%) were subsequently diagnosed with cancer. The overall rate of surgery was 39%, with a 33% colectomy rate in UC. Tacrolimus shows a clinical benefit in both CD and UC after 3months of treatment, but its long-term effectiveness and frequent adverse events remain relevant issues in clinical practice.

Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control?

BackgroundUlcerative colitis (UC) is primarily medically managed. Colectomy is required in patients with refractory disease or severe complications. Older studies have reported 20-year colectomy rates of over 50%, but recent studies showed decreased rates to 15%. Temporal trends in the use of colectomy in UC over the past decade (when the use of biologics has become widespread) are lacking. MethodsCase-control study using the National Inpatient Sample database for years of 2007, 2010, 2013, and 2016 was performed. The primary outcome was determining the temporal trends in the use of colectomy in hospitalized patients with UC. Secondary outcomes were determining the total number of admissions for patients with UC and associated trend in inflation-adjusted hospital costs, charge, and length of hospital stay (LOS). Multivariate regression analyses were used to adjust for other co-variables. Results443,043 patients with UC were identified, of which 19,208 underwent colectomy in the study period. The mean patient age was 52 years, and 47% were female. Five percent of hospitalized patients with UC underwent colectomy in 2007, while 2.7% of patients with UC had colectomy in 2016, representing a 46% decrease in colectomies in hospitalized patients in the study period. Patients with UC displayed adjusted odds of colectomy of 0.51 (p < 0.01), adjusted additional mean hospital costs decrease by − $2898 (p < 0.01), hospital charges increase by $26,554 (p < 0.01), LOS decrease by − 2.2 days (p < 0.01) in 2016 compared to 2007. ConclusionThe odds of colectomy in UC patients decreased significantly over the past decade, likely secondary to improved medical care.

P015 Persistent Disparities in Colectomy Rate in Ulcerative Colitis

P015 Persistent Disparities in Colectomy Rate in Ulcerative Colitis

Corticosteroid Treatment at Diagnosis: An Analysis of Relapses, Disease Extension, and Colectomy Rate in Ulcerative Colitis.

Ulcerative colitis is a chronic relapsing disease usually treated with mesalamine. The need of steroid therapy at diagnosis is generally considered as a poor prognostic factor. The aim of our study was to assess whether patients treated with corticosteroids at diagnosis have more clinical relapses, disease progression, or an increased risk of colectomy during a 5-year follow-up. We retrospectively evaluated patients who had received diagnosis of ulcerative colitis with a 5-year follow-up. Relapse was defined as a worsening of symptoms requiring an increase in medical treatment. Progression of disease was defined as a proximal extension of mucosal involvement, comparing the colonoscopy performed 5years after diagnosis with the first one. The need of corticosteroid treatment at diagnosis was correlated to number of relapses, disease progression, and colectomy rate. We included 230 patients, 116 of them (50%) treated with steroids at diagnosis. Multivariate analysis demonstrated that there is a strong correlation between corticosteroid use and number of relapses (p < 0.01), as well as with disease progression (p < 0.05). Seventeen patients (7.4%) underwent colectomy, but the correlation with steroids was not statistically significant. These data provide evidence that the need of corticosteroids at diagnosis is associated with a worse clinical outcome.

1041 – Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control?

1041 – Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control?

DOP61 A nationwide cohort study of colectomy rates for ulcerative colitis during the introduction of biologic therapy

DOP61 A nationwide cohort study of colectomy rates for ulcerative colitis during the introduction of biologic therapy

Ethnic and Demographic Differences in Colectomy Rates and Timing for Ulcerative Colitis: 2007-2014

Introduction: Ulcerative Colitis (UC) is a chronic inflammatory disease of the bowel, with one third of patients requiring a colectomy for fulminant disease and tissue dysplasia. In 2007, infliximab was approved for induction and maintenance of remission in UC, with some evidence to suggest a potential reduction in colectomies. The aim of this study is to examine relative colectomy rates for UC among different ethnicities from 2007 to 2014 in order to evaluate for development of new trends or disparities. Methods: The data source was the NIS database, from 2007 to 2014. Patients aged 5 years and older with a primary diagnosis of UC were used. Additional variables included race, age, gender, insurance coverage, region, hospital teaching status, hospital size, elective admission status, and zip code income quartile. Odds ratios for colectomy were calculated via logistic regression. Negative binomial regression modeling was used to observe associations between variables and time to colectomy. Results: Compared to Whites, the odds ratios of colectomy for Blacks (0.63, 95% C.I. 0.53-0.749, p<0.01), Hispanics (0.729, 95% C.I. 0.630-0.844, p< 0.01), and Asians (0.332, 95% C.I. 0.219-0.504, p< 0.01) were all significantly lower. However, Black (2.024, 95% C.I. 1.614-2.537, p< 0.01), Hispanic (1.295, 95% C.I. 1.078-1.557, p< 0.01), and Asian ethnicity (4.293, 95% C.I. 2.632-7.002, p< 0.01) were associated with increasing time until receipt of colectomy. Private insurance was associated with higher colectomy rates (1.545, 95% C.I. 1.325-1.802, p< 0.01), as was increasing hospital zip code income quartile (1.085, 95% C.I. 1.048-1.124, p< 0.01). Conclusion: Discrepancies in colectomy rates and timing are seen in our models which mirror closely findings in a prior study from 1999-2003 (Nguyen GC, et al. Racial and Geographic Variations in Colectomy Rates Among Hospitalized Ulcerative Colitis Patients. Clinical Gastroenterology and Hepatology 2006; 4: 1507-1513.e1). The consistency between our findings suggests that the availability of infliximab has not altered the relative differences in surgical management of inpatients of different ethnicities with UC flares. Closer study of utilization and response to UC therapy across ethnic and demographic lines is needed to better elucidate whether such practices are based on true phenotypic differences in disease or bias, as it appears white, wealthier patients continue to more readily and rapidly receive colectomies.598_A Figure 1. Number of Colectomies by Variable.598_B Figure 2. Colectomy Odds Ratios.598_C Figure 3. Negative Binomial Regression Analysis for Time to Colectomy.

326 - Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-Year-Follow-Up Data from the Swiss IBD Cohort Study

326 - Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-Year-Follow-Up Data from the Swiss IBD Cohort Study

Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-year Follow-up Data From the Swiss IBD Cohort Study.

Previous population-based studies in patients with ulcerative colitis [UC] revealed variable colectomy rates and colectomy-associated risk factors. Over the past two decades, a decrease in colectomy rates was observed. We assessed risk factors and colectomy rates over time in UC in the Swiss Inflammatory Bowel Disease Cohort Study [SIBDCS]. Prospectively collected SIBDCS data, including disease history, baseline characteristics at enrolment, and course of disease, were retrospectively analysed. Cumulative and adjusted annual colectomy rates were calculated. Among 1245 UC patients analysed [54.6% male], 114 [9.2%] underwent colectomy. We observed 5-, 10-, 15-, and 20-year cumulative colectomy rates after diagnosis of 4.1%, 6.4%, 10.4%, and 14.4% of patients, respectively. Male sex (odds ratio [OR] 1.54; p = 0.035), pancolitis at diagnosis [OR = 2.16; p = 0.005], younger age at diagnosis [OR 0.89 per 5 years of age; p = 0.006] and presence of extraintestinal manifestations [EIM] [OR 2.30; p < 0.001] were risk factors for undergoing colectomy. We did not observe a significant protective effect of smoking on colectomy risk [OR 0.64; p = 0.106]. The majority of colectomies were performed within first 10 years of disease onset, with a rapidly decreasing colectomy rate after 15 years. In patients diagnosed after 2003, colectomy was performed much earlier during and individual's disease course. Nevertheless, we found a significantly decreasing trend in yearly colectomy rates over time after 2005. Crude and adjusted colectomy rates in Swiss UC patients were lower than those reported previously in the literature, and decreased over time.