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Post-Operative Morbidity and Mortality of a Cohort of Steroid Refractory Acute Severe Ulcerative Colitis: Nationwide Multicenter Study of the GETECCU ENEIDA Registry

Ordás, I MD, PhD1; Domènech, E MD, PhD2; Mañosa, M MD, PhD2; García-Sánchez, V MD, PhD3; Iglesias-Flores, E MD3; Rodríguez-Moranta, F MD, PhD4; Márquez, L MD, PhD5; Merino, O MD6; Fernández-Bañares, F MD, PhD7; Gomollón, F MD, PhD8; Vera, M MD, PhD9; Gutiérrez, A MD, PhD10; LLaó, J MD, PhD11; Gisbert, J P MD, PhD12; Aguas, M MD, PhD13; Arias, L MD14; Rodríguez-Lago, I MD15; Muñoz, C MD, PhD16; Alcaide, N MD17; Calvet, X MD, PhD18; Rodríguez, C MD, PhD19; Montoro, M A MD, PhD20; García, S MD, PhD21; De Castro, M L MD, PhD22; Piqueras, M MD23; Pareja, L MD, PhD24; Ribes, J MD, PhD25,26,27; Panés, J MD, PhD1; Esteve, M MD, PhD7 on behalf of the ENEIDA registry of GETECCU

American Journal of Gastroenterology: July 2018 - Volume 113 - Issue 7 - p 1009–1016
doi: 10.1038/s41395-018-0057-0
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BACKGROUND: Despite the increased use of rescue medical therapies for steroid refractory acute severe ulcerative colitis, mortality related to this entity still remains high. We aimed to assess the mortality and morbidity related to colectomy and their predictive factors in steroid refractory acute severe ulcerative colitis, and to evaluate the changes in mortality rates, complications, indications of colectomy, and the use of rescue therapy over time.

METHODS: We performed a multicenter observational study of patients with steroid refractory acute severe ulcerative colitis requiring colectomy, admitted to 23 Spanish hospitals included in the ENEIDA registry (GETECCU) from 1989 to 2014. Independent predictive factors of mortality were assessed by binary logistic regression analysis. Mortality along the study was calculated using the age-standardized rate.

RESULTS: During the study period, 429 patients underwent colectomy, presenting an overall mortality rate of 6.3% (range, 0-30%). The main causes of death were infections and post-operative complications. Independent predictive factors of mortality were: age ≥50 years (OR 23.34; 95% CI: 6.46-84.311;p< 0.0001), undergoing surgery in a secondary care hospital (OR 3.07; 95% CI: 1.01-9.35;p= 0.047), and in an emergency setting (OR 10.47; 95% CI: 1.26-86.55;p= 0.029). Neither the use of rescue medical treatment nor the type of surgical technique used (laparoscopy vs. open laparotomy) influenced mortality. The proportion of patients undergoing surgery in an emergency setting decreased over time (p< 0.0001), whereas the use of rescue medical therapy prior to colectomy progressively increased (p> 0.001).

CONCLUSIONS: The mortality rate related to colectomy in steroid refractory acute severe ulcerative colitis varies greatly among hospitals, reinforcing the need for a continuous audit to achieve quality standards. The increasing use of rescue therapy is not associated with a worse outcome and may contribute to reducing emergency surgical interventions and improve outcomes.

1Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain. 2Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, CIBEREHD, Barcelona, Spain. 3Hospital Reina Sofía, IMIBIC, Cordoba's Univeristy, Cordoba, Spain. 4Gastroenterology Department, Hospital Universitario de Bellvitge, Barcelona, Spain. 5Gastroenterology Department, Hospital del Mar, Barcelona, Spain. 6Gastroenterology Department, Hospital de Cruces, Bilbao, Spain. 7Gastroenterology Department, Hospital Universitari Mútua Terrassa, CIBEREHD, Barcelona, Spain. 8Gastroenterology Department, Hospital Lozano Blesa, CIBEREHD, Zaragoza, Spain. 9Gastroenterology Department, Hospital Puerta de Hierro Majadahonda, Madrid, Spain. 10Gastroenterology Department, Hospital Universitario de Alicante, CIBEREHD, Alicante, Spain. 11Gastroenterology Department, Hospital de Sant Pau, Barcelona, Spain. 12Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, CIBEREHD, Madrid, Spain. 13Gastroenterology Department, Hospital la Fe, CIBEREHD, Valencia, Spain. 14Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain. 15Gastroenterology Department, Hospital de Galdakao, Bilbao, Spain. 16Gastroenterology Department, Hospital de Basurto, Bilbao, Spain. 17Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 18Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, CIBEREHD, Barcelona, Spain. 19Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain. 20Gastroenterology Department, Hospital San Jorge, Huesca, Spain. 21Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain. 22Gastroenterology Department, Complexo Hospitalario Universitario de Vigo-Instituto de Investigación Biomédica, Pontevedra, Spain. 23Gastroenterology Department, Consorci Sanitari de Terrassa, Barcelona, Spain. 24Catalonian Cancer Registry, Oncologist Director Plan of Catalonia, Barcelona, Spain. 25Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. 26Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain. 27Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.

Correspondence: M.E. (email: mariaesteve@mutuaterrassa.cat)

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A242, http://links.lww.com/AJG/A243

Received 13 April 2017; accepted 13 February 2018; Published online 1 May 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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