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P607 Post-operative mortality and predictive factors in a cohort of severe refractory ulcerative colitis patients from the ENEIDA Registry (1989–2013): a multicenter nationwide study

Ordas I.*1, Domenech E.2, Aguas M.3, Fernandez-Bañares F.4, García S.5, Peñalva M.6, Muñoz C.7, García-Sánchez V.8, Llaό J.9, Jiménez C.E.10, Merino O.11, Gomollόn F.12, Piqueras M.13, Vera M.14, Márquez L.15, De Castro M.16, Gutiérrez A.17, Cabriada J.L.18, Alcaide N.19, Calvet X.20, Montoro M.A.21, Arias L.22, Panés J.1, Esteve M.4

1Hospital Clinic Barcelona, Gastroenterology, Barcelona, Spain 2Hospital Universitari Germans Trias i Pujol, Gastroenterology, Barcelona, Spain 3Hospital La Fe, Gastroenterology, Valencia, Spain 4Hospital Universitari Mútua Terrassa, Gastroenterology, Barcelona, Spain 5Hospital Universitario Miguel Servet, Gastroenterology, Zaragoza, Spain 6Hospital Universitari Bellvitge, Gastroenterology, Barcelona, Spain 7Hospital de Basurto, Gastroenterology, Bilbao, Spain 8Hospital Reina Sofía, Gastroenterology, Cόrdoba, Spain 9Hospital Sant Pau, Gastroenterology, Barcelona, Spain 10Complejo Hospitalario de Navarra, Gastroenterology, Navarra, Spain 11Hospital de Cruces, Gastroenterology, Bilbao, Spain 12Hospital Lozano Blesa, Gastroenterology, Zaragoza, Spain 13Consorci Sanitari Terrassa, Gastroenterology, Barcelona, Spain 14Hospital Puerta de Hierro, Gastroenterology, Madrid, Spain 15Hospital del Mar, Gastroenterology, Barcelona, Spain 16Complejo Hospitalario de Vigo, Gastroenterology, Vigo, Spain 17Hospital Universitario de Alicante, Gastroenterology, Alicante, Spain 18Hospital de Galdakao, Gastroenterology, Bilbao, Spain 19Hospital Clínico Universitario de Valladolid, Gastroenterology, Valladolid, Spain 20Corporaciό Sanitària Universitària Parc Taulí, Gastroenterology, Barcelona, Spain 21Hospital San Jorge, Gastroenterology, Huesca, Spain 22Hospital General Yagüe, Gastroenterology, Burgos, Spain

Background

Meta-analysis from population-based studies report mortality rates associated to colectomy in ulcerative colitis (UC) around 5% while the reported rate in tertiary centers is close to 0%. However, little is known about factors related to post-operative mortality in the subpopulation of patients with severe refractory (SR-UC). Aim: to evaluate the mortality rate over time together with related factors in patients requiring colectomy due to SR-UC.

Methods

Patients requiring colectomy due to SR-UC from 22 Spanish hospitals adhered to the ENEIDA Registry from 1989 to 2013 have been included. In addition, all investigators reviewed their hospital discharge registries using “colitis” and “colectomy” as search terms. The following variables have been analyzed: age, gender, disease duration and extent, rescue medical therapies, type of surgery (urgent vs elective; open vs laparoscopic), hospital complexity (tertiary vs secondary) and period (1989–2001 vs 2002–2013). Percentages were compared using the χ2 or Fisher exact test as appropriate. Logistic regression analysis was used to evaluate predictive factors of death.

Results

A total of 424 patients have been included (253 male, age 42.3±16.4 years). Mortality rate associated to SR-UC flare was 6.4% (N=27/424). Causes of death were: infection 11, post-colectomy perforation 6, hemorrhage 4, multiorganic failure 4, others 2. Univariate analysis showed higher mortality in patients older than 50 years (p<0.0001) and in urgent colectomy (p<0.001). Colectomy rate was lower if SR-UC presented at diagnosis (p=0.02), it if was treated in tertiary centers (p=0.006) and in patients that received rescue medical treatment (p<0.001). There were no differences in mortality between periods (9.3% vs 4.8%; p=0.069). An age >50 [OR 26.0 (7.2–93.4)] and urgent colectomy [OR 13.2 (1.6–104.2)] were predictive factors of mortality whereas to be colectomized in a tertiary center [OR 0.2 (0.08–0.9)], after 2002 [OR 0.3 (0.1–0.9)] and to have a SR-UC at diagnosis [OR 0.1 (0.03–0.7)] reduced the risk independently.

Conclusion

Age, as surrogate marker of comorbidity, is the strongest factor related to post-operative mortality in SR-UC. Patients with SR-UC requiring colectomy should be operated in tertiary hospitals.