Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome

Abstract

Background/Aims: Approximately 20% of patients undergoing surgery for ulcerative colitis will retain their rectum. A single-stage proctocolectomy could be an appropriate procedure in patients who are definitely not candidates for a later restorative procedure, but it is generally not advised in acutely ill patients. The aim was to investigate the safety of one-stage proctocolectomy under elective and non-elective circumstances, with specific reference to identifying possible risk factors for postoperative complications. Methods: A retrospective cohort study, including 54 consecutive patients undergoing proctocolectomy for ulcerative colitis. Out of these, 27 (50%) were admitted non-electively. Results: Postoperative complications were observed in 30 patients (54%). Wound dehiscence, wound infection, and impaired perineal wound healing were observed in 10 (18.5%), 8 (14.8%), and 10 (18.5%) of the patients, respectively. There was no difference between elective and non-elective cases. Complications were observed more often in patients receiving high-dose corticosteroids (18/26 vs. 12/28; p = 0.06). Impaired perineal wound healing and reoperations were observed more often in the corticosteroid-treated group (8/26 vs. 2/28; p = 0.04 and 12/26 vs. 1/28; p = 0.0003). Conclusions: Proctocolectomy is equally safe under elective and non-elective situations, but a preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

“…In patients having proctocolectomy, corticosteroids are associated with an increased risk of impaired wound healing and need for re-operation 935. There is no evidence of increased complication risk for patients taking immunomodulators (mercaptopurine, ciclosporin) who have ileoanal pouch surgery950 or IBD surgery generally 941.…”

A Nationwide Analysis of Preoperative Planning on Operative Times and Postoperative Complications in Total Knee Arthroplasty

“…[11][12][13] A study comparing single-stage proctocolectomy for ulcerative colitis treatment found no significant differences in complication rates, such as wound dehiscence and infection when patients underwent either elective or nonelective surgery. 12 Similarly, Putnam et al 13 assessed risk factors for postoperative outcomes after Ladd's procedure using the pediatric NSQIP database and found that despite having a longer LOS (p < 0.001), patients who underwent nonelective procedures had similar rates of postoperative complications (p < 0.001) compared with elective patients. Although these studies have contrasting results, they represent findings from fields outside of orthopaedics.…”

The Handling of the Rectal Stump Does Not Affect Severe Morbidity After Subtotal Colectomy For Ulcerative Colitis: A Retrospective Cohort Study

“…Possibly emergency surgery could be a risk factor for complications, but previous studies have shown high dose steroids, low albumin, low BMI, and long duration of active disease prior to surgery to be of more significance, and thus, long-standing duration of active disease prior to surgery might be of equal, or greater, importance than if the surgery was performed within 48 h or not (6,(22)(23)(24). In our study, the number of patients who had emergency surgery was similar in both groups, and we have chosen not to perform any further analysis regarding this.…”