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

Longitudinal trends in direct costs and healthcare utilization ascribable to inflammatory bowel disease in the biologic era: a nationwide, population‐based study

“…In line with these insurance coverage extensions, the ratio of patients who underwent surgery to the total number of patients decreased significantly a few years later, and the ratio of total inpatient visits to total visit number also decreased since 2012, indicating that anti‐TNF agents decrease the number of hospitalizations and surgeries, although this effect remains controversial. Other studies in Western countries found that the rate of IBD‐attributable hospitalization and surgery decreased with the introduction of biologics 43,44 . Similarly, a recent large population‐based study of clinical outcomes in patients with IBD over 30 years in Korea observed that the surgery rate decreased constantly during the intervening period, probably due to the effect of biologics 45 .…”

“…Other studies in Western countries found that the rate of IBD-attributable hospitalization and surgery decreased with the introduction of biologics. 43,44 Similarly, a recent large population-based study of clinical outcomes in patients with IBD over 30 years in Korea observed that the surgery rate decreased constantly during the intervening period, probably due to the effect of biologics. 45 Another study showed that early use of anti-TNF agents improved the clinical outcomes of IBD, including decreased surgery rate and hospitalization 1 year after the treatment.…”

Medical therapy versus surgery in moderate-to-severe ulcerative colitis

“…In a recent large case-control study, over 443,043 patients with UC were identified in the United States, of which 19,208 underwent colectomy during the study period. The authors found the adjusted odds of colectomy of 0.51 ( p < 0.01), adjusted additional mean hospital costs decreased by $2898 ( p < 0.01), hospital charges increased by $26,554 ( p < 0.01), and length of hospitalization decreased by 2.2 days ( p < 0.01) in 2016 compared with 2007, likely due to improved medical care and the ability to use more drugs in patients refractory to conventional therapy [42] . Another study confirmed that the rate of surgery in UC has decreased in the biological agent era, but the indications to colectomy have not changed in the last decade [43] .…”

Role of hospitalization for inflammatory bowel disease in the post-biologic era

“…In both patient populations, emergency intestinal resections carry higher morbidity and mortality compared to elective cases[ 61 ]. Fortunately, the rates of emergency surgery for both UC and CD have been declining[ 58 , 59 , 62 - 64 ]. With this shift towards elective surgeries, operative strategies have also been affected.…”