Share this article on:

Postoperative Complications Following Colectomy for Ulcerative Colitis in Children

Soon, Ing Shian*; Wrobel, Iwona*; deBruyn, Jennifer C.C.*; Sauve, Reg*; Sigalet, David L.; Kaplan, Belle S.; Proulx, Marie-Claude; Kaplan, Gilaad G.§

Journal of Pediatric Gastroenterology & Nutrition: June 2012 - Volume 54 - Issue 6 - p 763–768
doi: 10.1097/MPG.0b013e318245265c
Original Articles: Gastroenterology

Background and Aims: Colectomy rates for ulcerative colitis (UC) and data on postcolectomy complications in children are limited. Thus, we assessed colectomy rates, early postcolectomy complications, and clinical predictors in children with UC undergoing a colectomy.

Methods: Children (18 years old or older) with UC who underwent colectomy from 1983 to 2009 were identified (n = 30). All of the medical charts were reviewed. The diagnostic accuracy of International Classification of Diseases codes for UC and colectomy were validated. The primary outcome was postoperative complications defined as Clavien-Dindo classification grade II or higher. The yearly incidence of colectomies for pediatric UC was calculated and temporal trends were evaluated.

Results: The sensitivity and positive predictive value of UC and colectomy International Classification of Diseases codes were 96% and 100%, respectively. The median ages at UC diagnosis and colectomy were 10.9 and 12.1 years, respectively. All of the children had pancolitis and 63% underwent emergent colectomy. Postoperatively, 33% experienced at least 1 complication. Patients with emergent colectomy were more likely to have a postoperative complication compared with patients with elective colectomy (90% vs 50%; P = 0.03). For emergent colectomy, postoperative complications were associated with a disease flare of ≥2 weeks before admission (60% vs 0%; P = 0.03) and >2 weeks from admission to colectomy (78% vs 22%; P = 0.04). The average annual rate of pediatric colectomy was 0.059/100,000 person-years and stable from 1983 to 2009 (P > 0.05).

Conclusions: Colectomy UC was uncommon and rates have remained stable. Postcolectomy complications were common, especially in patients undergoing emergent colectomy. Optimizing timing of colectomy may reduce postoperative complications.

*Department of Pediatrics

Department of Surgery

Department of Community Health Sciences

§Department of Medicine, University of Calgary, Calgary, Canada.

Address correspondence and reprint requests to Gilaad G. Kaplan, MD, MPH, FRCPC, Assistant Professor, Departments of Medicine and Community Health Sciences, University of Calgary, Teaching Research and Wellness Center, 3280 Hospital Dr NW, 6th Floor, Room 6D17, Calgary, AB T2N 4N1, Canada (e-mail: ggkaplan@ucalgary.ca).

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 Website (www.jpgn.org).

Received 19 September, 2011

Accepted 5 December, 2011

I.S. is supported by the Alberta Children's Hospital Research Institute for Child and Maternal Health and the Canadian Institute of Health Research (CIHR) Training Program in Genetics, Child Development and Health research fellowship. G.G.K. is supported through a New Investigator Award from the CIHR and a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research. The authors received funding from the MSI Foundation.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN