Post-Operative Morbidity and Mortality of a Cohort of Steroid Refractory Acute Severe Ulcerative Colitis: Nationwide Multicenter Study of the GETECCU ENEIDA Registry
Por:
Ordas, I, Domenech, E, Manosa, M, Garcia-Sanchez, V, Iglesias-Flores, E, Rodriguez-Moranta, F, Marquez, L, Merino, O, Fernandez-Banares, F, Gomollon, F, Vera, M, Gutierrez, A, LLao, J, Gisbert, JP, Aguas, M, Arias, L, Rodriguez-Lago, I, Munoz, C, Alcaide, N, Calvet, X, Rodriguez, C, Montoro, MA, Garcia, S, De Castro, ML, Piqueras, M, Pareja, L, Ribes, J, Panes, J and Esteve, M
Publicada:
1 jul 2018
Resumen:
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.
Filiaciones:
Ordas, I:
Univ Barcelona, Dept Gastroenterol, Hosp Clin Barcelona, IDIBAPS,CIBEREHD, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Gastroenterol, CIBEREHD, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Gastroenterol, CIBEREHD, Barcelona, Spain
Garcia-Sanchez, V:
Cordobas Univ, Hosp Reina Sofia, IMIBIC, Cordoba, Spain
Iglesias-Flores, E:
Cordobas Univ, Hosp Reina Sofia, IMIBIC, Cordoba, Spain
Rodriguez-Moranta, F:
Hosp Univ Bellvitge, Dept Gastroenterol, Barcelona, Spain
Marquez, L:
Hosp del Mar, Dept Gastroenterol, Barcelona, Spain
Merino, O:
Hosp Cruces, Dept Gastroenterol, Bilbao, Spain
Fernandez-Banares, F:
Hosp Univ Mutua Terrassa, Dept Gastroenterol, CIBEREHD, Barcelona, Spain
Gomollon, F:
CIBEREHD, Hosp Lozano Blesa, Dept Gastroenterol, Zaragoza, Spain
Vera, M:
Hosp Puerta Hierro Majadahonda, Dept Gastroenterol, Madrid, Spain
Gutierrez, A:
Hosp Univ Alicante, Dept Gastroenterol, CIBEREHD, Alicante, Spain
LLao, J:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Barcelona, Spain
Gisbert, JP:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, CIBEREHD, Madrid, Spain
Aguas, M:
CIBEREHD, Hosp Fe, Dept Gastroenterol, Valencia, Spain
Arias, L:
Hosp Univ Burgos, Dept Gastroenterol, Burgos, Spain
Rodriguez-Lago, I:
Hosp Galdakao, Dept Gastroenterol, Bilbao, Spain
Munoz, C:
Hosp Basurto, Dept Gastroenterol, Bilbao, Spain
Alcaide, N:
Hosp Clin Univ Valladolid, Dept Gastroenterol, Valladolid, Spain
Calvet, X:
Corp Sanitaria Univ Parc Tauli, CIBEREHD, Dept Gastroenterol, Barcelona, Spain
Rodriguez, C:
Complejo Hosp Navarra, Dept Gastroenterol, Navarra, Spain
Montoro, MA:
Hosp San Jorge, Dept Gastroenterol, Huesca, Spain
Garcia, S:
Hosp Univ Miguel Servet, Dept Gastroenterol, Zaragoza, Spain
De Castro, ML:
Complexo Hosp Univ Vigo, Inst Invest Biomed, Gastroenterol Dept, Pontevedra, Spain
Piqueras, M:
Consorci Sanitari Terrassa, Dept Gastroenterol, Barcelona, Spain
Pareja, L:
Catalonian Canc Registry, Barcelona, Spain
Ribes, J:
Canc Plan Catalan Govt, Barcelona, Catalonia, Spain
Univ Barcelona, Sch Med, Dept Clin Sci, Barcelona, Catalonia, Spain
Bellvitge Biomed Res Inst IDIBELL, Canc Epidemiol, Barcelona, Catalonia, Spain
Panes, J:
Univ Barcelona, Dept Gastroenterol, Hosp Clin Barcelona, IDIBAPS,CIBEREHD, Barcelona, Spain
Esteve, M:
Hosp Univ Mutua Terrassa, Dept Gastroenterol, CIBEREHD, Barcelona, Spain
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