Colectomy rates for ulcerative colitis in England 2003‐2016

Abstract

Summary Background 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. Aims To investigate temporal trends in colectomy for UC using English population data. Methods 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. Results Emergency cohort: 37 981 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 90 days following emergency admission, with no significant reduction ≥1 year. 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: 17 580 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. Conclusion 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.

The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

“… 19 , 20 However, HES analysis of emergency admissions for UC before the pandemic has demonstrated a decrease in short‐term colectomy rate in recent years that does not persist long‐term. 20 The PROTECT‐ASUC found that the practice of gastroenterologists and colorectal surgeons had changed, with more patients receiving rescue therapy in the form of biologicals, ciclosporin or tofacitinib. 17 This study suggests the trend to delay colectomy for patients undergoing emergency admission for ulcerative colitis has been exacerbated due to the pandemic.…”

“…Some studies suggest that colectomy rate is decreasing in the era of access to biologic medications 19,20 . However, HES analysis of emergency admissions for UC before the pandemic has demonstrated a decrease in short‐term colectomy rate in recent years that does not persist long‐term 20 . The PROTECT‐ASUC found that the practice of gastroenterologists and colorectal surgeons had changed, with more patients receiving rescue therapy in the form of biologicals, ciclosporin or tofacitinib 17 .…”

“…The evidence regarding UC colectomy rates in recent years is conflicting. Some studies suggest that colectomy rate is decreasing in the era of access to biologic medications 19,20 . However, HES analysis of emergency admissions for UC before the pandemic has demonstrated a decrease in short‐term colectomy rate in recent years that does not persist long‐term 20 .…”

How has the disease course of pediatric ulcerative colitis changed throughout the biologics era? A comparison with the IBSEN study

“…We confirmed that steroid dependency could be avoided through the use of biological agents in patients with high-severity UC (Figure 3 ). Since colectomy, like the length of the steroid-free period, is an important factor when evaluating long-term outcomes, other studies have also reported on colectomy rates according to treatment[ 37 - 39 ]. In this study, only 1 patient in Group A underwent colectomy due to uncontrolled hematochezia, so it was not possible to compare colectomy as a long-term outcome.…”

A review of the therapeutic management of ulcerative colitis

“…However, remission rates range between 30% and 40% with most advanced therapies and data suggest that colectomy rates are not decreasing despite biologics. 119 A prospective population-based cohort study has also shown similar 5-year surgery, hospitalisation and disease progression rates compared to cohorts from 20 years ago, despite earlier biologic therapy. 120 Taken together with the complex, incompletely understood and evolving immunobiology of IBD, it highlights a major unmet need for other therapeutic targets to abrogate the inflammatory response.…”