As in previous studies, patients were at increased risk for morbidity and mortality from colectomy surgery if they were older (age >64), required emergent surgery, or had at least two comorbidities.

Few population-based studies have been conducted on postoperative complications of colectomy in patients with ulcerative colitis (UC). One study involving >7000 patients in the U.S. reported that increased age, comorbidities, and emergent operations were risk factors for increased morbidity and mortality and that hospitals performing the highest volume of procedures had the lowest postoperative mortality rates . Now, investigators have used data from a population-based hospital system in Calgary, Canada, to explore predictors of postoperative complications among 666 patients who underwent colectomy for UC during a 13-year period.

During hospitalization for surgery, mortality was 1.5%, and 12.2% of patients developed postoperative infections. Risk factors for postoperative complications were age >64 (odds ratio, 2.0), emergent surgery (OR, 1.6), and presence of >2 comorbidities (OR, 1.9). For infectious complications, the risks associated with these factors increased (ORs, 2.9, 2.9, and 2.6, respectively), and male sex was also a risk factor (OR, 1.8). Undergoing emergent surgery >14 days after admission was associated with increased risk both for overall complications and for infections specifically (OR, 3 for both). Among patients who underwent emergent surgery, current smoking and presence of preoperative complications were each associated with a threefold increase in risk for serious postoperative complications (i.e., requiring procedural intervention or more-intense therapy).

Comment: This study confirms widely accepted principles for managing colectomy candidates with UC. Elders are at increased risk for complications. Patients with multiple comorbidities are also at increased risk, and medical management to optimize control of comorbidities is important. For patients admitted to the hospital for emergent care, medical management should be optimized early, and decisions to proceed with surgery should be made early when medical management fails. Immunosuppressants do not need to be avoided prior to colectomy, although previous studies have found that they increase risk for postoperative complications in elective UC surgery.

Source: Journal Watch Gastroenterology .