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Surgery for Ulcerative Colitis Is Associated with a High Rate of Readmissions at 30 Days

Feuerstein, Joseph D. MD*; Jiang, Zhenghui G. MD*; Belkin, Edward MD; Lewandowski, Jeffrey J. BS; Martinez-Vazquez, Manuel MD§; Singla, Anand MD; Cataldo, Thomas MD; Poylin, Vitaliy MD; Cheifetz, Adam S. MD*

doi: 10.1097/MIB.0000000000000473
Original Clinical Articles

Background: Currently, the predictors of readmission after colectomy specifically for ulcerative colitis (UC) are poorly investigated. We sought to determine the rates and predictors of 30-day readmissions after colectomy for UC.

Methods: Patients undergoing total proctocolectomy and end ileostomy, abdominal colectomy with end ileostomy, proctocolectomy with ileoanal pouch anastomosis (IPAA) formation and diverting ileostomy, one stage IPAA, or abdominal colectomy with ileorectal anastomosis at a tertiary care center between January 2002 and January 2012 for UC were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed. The electronic record system was reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for readmissions within 30 days of surgery. Univariate and multivariate analyses were performed using Stata v.13.

Results: Two hundred nine patients with UC underwent a colectomy. Forty-three percent had a proctocolectomy with IPAA and diverting ileostomy and 32% had abdominal colectomy with end ileostomy. Seventy-six percent of surgeries were due to failure of medical therapy and 68% of patients were electively admitted for surgery. Thirty-two percent (n = 67/209) of the cohort was unexpectedly readmitted within 30 days. In multivariate model, proctocolectomy with IPAA and diverting ileostomy (odds ratio [OR] = 2.11; 95% CI, 1.06–4.19; P = 0.033) was the only significant predictor of readmission. Hospital length of stay >7 days (OR = 1.82; 95% CI, 0.98–3.41; P = 0.060), presence of limited UC (OR = 2.10; 95% CI, 0.93–4.74; P = 0.074), and steroid before admission (OR = 1.69; 95% CI, 0.90–3.2; P = 0.100) trended toward significance.

Conclusions: Surgery for UC is associated with a high rate of readmission. Further prospective studies are necessary to determine the means to reduce these readmissions.

Article first published online 27 May 2015.

*Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

Department of Medicine, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts;

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

§Gastroenterology Service, Dr. José Eleuterio González University Hospital, Monterrey, Mexico;

Department of Medicine and Division of Gastroenterology, University of Washington School of Medicine, University of Washington, Seattle, Washington; and

Department of Surgery and Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Reprints: Joseph D. Feuerstein, MD, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 8E, Boston, MA 02215 (e-mail: jfeuerst@bidmc.harvard.edu).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

A. S. Cheifetz received consulting or grants from AbbVie, Janssen Pharmaceuticals, Warner Chilcott, Given Imaging, Prometheus Labs, Pfizer, and Takeda. The other authors have no conflict of interest to disclose.

Guarantor of the article: J. D. Feuerstein.

Received March 19, 2015

Accepted April 14, 2015

© Crohn's & Colitis Foundation of America, Inc.
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