Is the need for inflammatory bowel disease surgery diminishing in the biologic era?

Faiz, Omar; Worley, Guy

doi:10.1111/codi.14588

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…This study utilised a cohort of patients undergoing non‐elective admissions with UC in order to identify those patients who are more likely to require colectomy; hospitalisation for UC itself is a risk factor for subsequent colectomy 39 . The efficacy of modern medical salvage and its translation to long‐term colectomy avoidance has been scrutinised in the scientific literature 40,41 . In this study the modest decreases in short‐term colectomy rates are not reflected in medium‐term colectomy rates.…”

Section: Discussionmentioning

confidence: 99%

Colectomy rates for ulcerative colitis in England 2003‐2016

Worley

Almoudaris

Bassett

et al. 2020

Aliment Pharmacol Ther

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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.

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Section: Discussionmentioning

confidence: 99%

Colectomy rates for ulcerative colitis in England 2003‐2016

Worley

Almoudaris

Bassett

et al. 2020

Aliment Pharmacol Ther

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“…Independent of our conclusions, the most important outcome for people suffering from this life‐long relapsing condition is improved quality of life. Focusing on “colectomy‐free discharge” while relationships and jobs are lost and education is postponed is perhaps missing the wood for the trees 7,8 . Quality of life and decision‐making studies regarding UC surgery such as SOQCS and DISCUSS are welcome additions to the IBD research portfolio 9,10 .…”

Section: Figurementioning

confidence: 99%

Editorial: time trends in colectomy rates for ulcerative colitis in England—mixed methods brings mixed messages? Authors' reply

Worley

Faiz

2021

Aliment Pharmacol Ther

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“…Whether infliximab therapy has unequivocally provided a sustained reduction in colectomy rates long term continues to be debated. [19][20][21] Long-term follow-up of early trials demonstrated that colectomy was still required in up to 50% of patients following infliximab therapy at 5 years. [22][23][24][25] A recent UK population study also showed that while the short term colectomy rate was reduced for emergently admitted patients with at least moderate UC treated with infliximab, the colectomy free survival did not persist beyond 1 year and the rates of colectomy at 3 years were not significantly different to the pre biologic era.…”

Section: Introductionmentioning

confidence: 99%

“…Whether infliximab therapy has unequivocally provided a sustained reduction in colectomy rates long term continues to be debated 19–21 . Long‐term follow‐up of early trials demonstrated that colectomy was still required in up to 50% of patients following infliximab therapy at 5 years 22–25 .…”

Section: Introductionmentioning

confidence: 99%

Reducing rate of total colectomies for ulcerative colitis but higher morbidity in the biologic era: an 18‐year linked data study from New South Wales Australia

Giddings,

Ng,

Solomon

et al. 2023

ANZ Journal of Surgery

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BackgroundThis study aims to investigate the trends in UC surgery in New South Wales (NSW) at a population level.MethodsA retrospective data linkage study of the NSW population was performed. Patients of any age with a diagnosis of UC who underwent a total abdominal colectomy (TAC) ± proctectomy between Jul‐2001 and Jun‐2019 were included. The age adjusted population rate was calculated using Australian Bureau of Statistics data. Multivariable linear regression modelled the trend of TAC rates, and assessed the effect of infliximab (listed on the Pharmaceutical Benefits Scheme for UC in Apr‐2014).ResultsA total of 1365 patients underwent a TAC ± proctectomy (mean age 47.0 years (±18.6), 59% Male). Controlling for differences between age groups, the annual rate of UC TACs decreased by 2.4% each year (95% CI 1.4%–3.4%) over the 18‐year period from 1.30/100000 (2002) to 0.84/100000 (2019). An additional incremental decrease in the rate of TACs was observed after 2014 (OR 0.83, 95% CI 0.69–1.00). There was no change in the proportion of TACs performed emergently over the study period (OR 1.02, 95% CI 0.998–1.04). The odds of experiencing any perioperative surgical complication (aOR 1.54, 95% CI 1.01–2.33, P = 0.043), and requiring ICU admission (aOR 1.85, 95% CI 1.24–2.76, P = 0.003) significantly increased in 2014–2019 compared to 2002–2007.ConclusionsThe rate of TACs for UC has declined over the past two decades. This rate decrease may have been further influenced by the introduction of biologics. Higher rates of complications and ICU admissions in the biologic era may indicate poorer patient physiological status at the time of surgery.

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Is the need for inflammatory bowel disease surgery diminishing in the biologic era?

Cited by 3 publications

References 14 publications

Colectomy rates for ulcerative colitis in England 2003‐2016

Colectomy rates for ulcerative colitis in England 2003‐2016

Editorial: time trends in colectomy rates for ulcerative colitis in England—mixed methods brings mixed messages? Authors' reply

Reducing rate of total colectomies for ulcerative colitis but higher morbidity in the biologic era: an 18‐year linked data study from New South Wales Australia

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