Prolonged preoperative hospitalization correlates with worse outcomes after colectomy for acute fulminant ulcerative colitis

Coakley, Brian A.; Telem, Dana A.; Nguyen, Scott Q.; Dallas, Kai; Divino, Celia M.

doi:10.1016/j.surg.2012.08.002

Cited by 48 publications

(46 citation statements)

References 16 publications

(15 reference statements)

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“…In our overall experience, a laparoscopic approach was associated with lower morbidity (especially for minor complications) and a shorter hospital stay. However, this was at the expense of a longer mean operative time as noted similarly by others [8][9][10]18,25,[28][29][30][31]. In fact, the two studied populations (open and laparoscopic) were not entirely similar (more men, older and higher ASA score in the open group), and these discrepancies might at least in part explain the differences in outcomes [9].…”

Section: Discussionmentioning

confidence: 73%

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

et al. 2017

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Section: Discussionmentioning

confidence: 73%

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

et al. 2017

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“…Consequently, the efficacy and relatively good safety profile of rescue therapy in our study patients cannot be generalized to all refractory UC patients. Recently, Coakley et al [17] reported an association between prolonged medical treatment and poor postoperative outcomes in fulminant UC patients. Thus, it is crucial to identify and carefully select for UC patients who will benefit from rescue therapy especially with regard to efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Salvage Therapy and Its Effect on Operative Outcomes in Patients with Ulcerative Colitis

Saito

Nagahori²,

Fujii³

et al. 2014

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Aims: To evaluate the efficacy and safety of salvage therapy, and to identify risk factors of operative complications among hospitalized ulcerative colitis (UC) patients. Patients and Methods: We evaluated 88 UC patients hospitalized at our center between April 2010 and November 2012. We compared characteristics of corticosteroid-refractory patients treated with calcineurin inhibitor and those with infliximab as second-line therapy. Furthermore, we compared the characteristics of operative and nonoperative patients. The association between perioperative treatments and complications was also investigated. Results: Calcineurin inhibitor and infliximab were used in 42 and 22 patients, respectively. We found no difference in the clinical background between them. Efficacy rates were 67 and 50%, respectively. Eight out of 10 nonresponders of each treatment were treated with the other drug as third-line therapy. The efficacy rates of calcineurin inhibitor and infliximab as the third-line therapy were 75 and 50%, respectively. Operative patients had more severe disease (87.5 vs. 31%, p < 0.01), higher Lichtiger score (14.1 vs. 11.5, p < 0.01), higher Rachmilewitz endoscopic index (10.5 vs. 8.4, p < 0.01), higher C-reactive protein (7.6 vs. 4.0, p = 0.015) and lower serum albumin (3.1 vs. 3.6, p = 0.014) than nonoperative patients. Complications were observed in 7 out of 16 (44 %) operative patients. Postoperative complications were not increased even when patients were treated with second- or third-line therapy. However, the complication rate in corticosteroid users was 54.5 (6/11) and 20% (1/5) in nonusers. Conclusions: Third-line salvage therapy is effective and tolerable in carefully selected UC patients. Perioperative use of corticosteroids may lead to more adverse outcomes.

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“…emergency operation) [5] . Especially in UC patients, a prolonged preoperative hospital stay [6][7][8][9] and use of immunosuppressive drugs [10][11][12][13][14] are also thought to be related to the occurrence of surgical complications.…”

Section: Discussionmentioning

confidence: 99%

“…De Silva et al 188 [8] reported that patients admitted to the hospital under emergency conditions who did not respond to medical treatment had worse outcomes when surgery was performed ≥ 14 days after admission. Regarding acute fulminant UC, Coakley et al [9] showed that patients who underwent surgery within the first 72 h of admission had a significantly lower risk of developing major complications than patients undergoing surgery after 72 h. These results suggest that delayed surgery is associated with an increased risk of postoperative complications in various situations.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Medical Therapy Increases the Risk of Surgical Complications in Patients with Severe Ulcerative Colitis

et al. 2016

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Aims: To determine the risk factors of surgical complications and the optimal timing of surgery for patients with severe ulcerative colitis (UC). Methods: One hundred one UC patients who had undergone surgery for a severe indication were retrospectively reviewed. Indications included severe disease unresponsive to medical therapy, massive bleeding, toxic megacolon, and colon perforation. Outcomes were compared based on the occurrence or absence of surgical complications. Patients with severe disease unresponsive to medical therapy were investigated separately to determine the optimal timing of surgery. Results: There was no significant difference regarding the use of rescue therapy. The duration of all medical therapy for a severe attack was the only significant factor associated with a surgical complication (p = 0.032). In patients with severe disease unresponsive to medical therapy, the receiver operating characteristic curve analysis showed that 30.5 days was the length of medical therapy after which the risk of surgical complications significantly increased. Conclusions: In patients with severe UC, rescue therapy itself was not related to an increased risk of surgical complications. However, prolonged medical therapy increased the risk of surgical complications. Patients should undergo surgery within 30 days from the institution of medical therapy for a severe attack.

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Prolonged preoperative hospitalization correlates with worse outcomes after colectomy for acute fulminant ulcerative colitis

Cited by 48 publications

References 16 publications

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

Efficacy of Salvage Therapy and Its Effect on Operative Outcomes in Patients with Ulcerative Colitis

Prolonged Medical Therapy Increases the Risk of Surgical Complications in Patients with Severe Ulcerative Colitis

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