Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications
Randall J., Singh B., Warren BF., Travis SPL., Mortensen NJ., George BD.
Abstract Background This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome. Methods All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded. Results Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1–22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch–anal anastomosis in 57. During a median follow-up of 5·4 (range 0·5–9·0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0·036). Conclusion Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications.