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P149. Risk factors for post-colectomy complications in patients with ulcerative colitis

Y. Hirayama, T. Ando, K. Ishiguro, O. Maeda, O. Watanabe, K. Morise, K. Maeda, M. Matsushita, K. Furukawa, K. Funasaka, M. Nakamura, R. Miyahara, H. Goto, Nagoya University Graduate School of Medicine, Departmant of Gastroenterology and Hepatology, Nagoya, Japan

Background

Despite a wide range of treatment options, a significant proportion of patients with ulcerative colitis (UC) remain refractory to medical therapy. About 20–30% of patients with UC may require colectomy for treatment of their disease, and sometimes experience postoperative complications.

Methods

We conducted this study in an attempt to clarify the risk factors for post-colectomy complications. The records of 72 consecutive patients who underwent proctocolectomy with ileal pouch-anal anastomosis or subtotal colectomy with ileostomy for UC from April 2003 to December 2012 were reviewed. Statistical analysis included univariate and multivariate studies of clinical and biological parameters.

Results

72 patients (M/F: 43/29) who underwent colectomy for UC were enrolled. 11 cases of dysplasia and colitic cancer were also included. Age at onset was 29.3±14.4 years. Age at surgery was 36.4±15.6 years. Disease duration was 7.0±6.4 years. The disease locations were 53 cases of pancolitis (73.6%), and 16 cases of left-sided colitis (27.2%). The clinical courses were 51 cases of relapse and remission (70.8%), 15 cases of chronically active colitis (20.8%), and 6 cases of fulminant or initial severe attack (8.4%). In terms of post-colectomy complication, there were 14 cases of intra-abdominal abscess, 13 cases of bowel obstruction, 8 cases of wound infection, 4 cases of bleeding and 2 cases of anastomotic leak (including overlapping cases). In emergency situations, 16 patients (22.2%) underwent colectomy due to toxic megacolon, severe bleeding, and perforation. Between emergency surgery (group A, n = 16) and elective surgery (group B, n = 56), there was no statistically significant difference in terms of the occurrence of complications [group A: 7/16 (43.6%), group B: 19/56 (33.9%)]. The analysis of risk factors for post-colectomy complications with univariate and multivariate studies was respectively performed in both groups. In group A, there was no significant factor. In group B, <20 years old at onset: (OR: 4.07, 95% CI: 1.17–14.15), >7 years disease duration (OR: 6.65, 95% CI: 1.79–24.73), and >200 mg/week preoperative prednisone use (OR: 9.80, 95% CI: 2.50–38.41) were statistically significant.

Conclusion

The factors that correlated with an increased risk of post-colectomy complications in patients with UC were young onset (<20 y/o), long-lasting UC (>7 years), and a significant amount of preoperative prednisone use (>200 mg/week). To prevent such complications, we should treat these patients carefully.