Trends in the surgical treatment of ulcerative colitis over time

Increased mortality and centralization of care

Michelle C. Ellis, Brian S. Diggs, John Vetto, Daniel Herzig

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: New medical therapies available to ulcerative colitis (UC) patients have influenced operative mortality for patients requiring colectomy. We sought to examine trends in treatment and outcome for UC patients treated surgically. Methods: A review of 36,447 UC patients from the Nationwide Inpatient Sample was performed, comparing the pre-monoclonal antibody era (1990-1996) to the present-day era (2000-2006). Patients treated with total colectomy with ileostomy or proctocolectomy with ileal pouch were reviewed for outcome measures and practice setting (rural, urban non-teaching, urban teaching). Our main outcome measures were in-hospital mortality, length of stay, and total charges. Results: Total colectomy (n = 30,362) was performed five times more often than proctocolectomy (n = 6,085). When comparing the two study periods, mortality after total colectomy increased 3.8% to 4.6% (p = 0.0003). This difference was primarily due to increasing mortality in later years; when 1995-1996 was compared to 2005-2006, mortality increased from 3.6% to 5.6% (p <0.0001). There were no deaths in the proctocolectomy group (p <0.0001). The distribution by practice setting shifted over the two study periods, decreasing in rural (7.0% to 4.8%) and urban non-teaching (43.7% to 28.4%) centers, and increasing in urban teaching centers (49.3% to 66.8%). The total inflation-adjusted charges per patient increased significantly ($34,638 vs. $43,621; p <0.0001). Conclusions: The mortality rate after total colectomy is increasing, and the difference is accentuated in the years since widespread use of monoclonal antibody therapy. The care of these patients is being shifted to urban teaching centers and is becoming more expensive.

Original languageEnglish (US)
Pages (from-to)671-676
Number of pages6
JournalWorld Journal of Surgery
Volume35
Issue number3
DOIs
StatePublished - Mar 2011

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Ulcerative Colitis
Colectomy
Mortality
Teaching
Therapeutics
Monoclonal Antibodies
Outcome Assessment (Health Care)
Colonic Pouches
Ileostomy
Economic Inflation
Hospital Mortality
Inpatients
Length of Stay
Patient Care

ASJC Scopus subject areas

  • Surgery

Cite this

Trends in the surgical treatment of ulcerative colitis over time : Increased mortality and centralization of care. / Ellis, Michelle C.; Diggs, Brian S.; Vetto, John; Herzig, Daniel.

In: World Journal of Surgery, Vol. 35, No. 3, 03.2011, p. 671-676.

Research output: Contribution to journalArticle

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abstract = "Background: New medical therapies available to ulcerative colitis (UC) patients have influenced operative mortality for patients requiring colectomy. We sought to examine trends in treatment and outcome for UC patients treated surgically. Methods: A review of 36,447 UC patients from the Nationwide Inpatient Sample was performed, comparing the pre-monoclonal antibody era (1990-1996) to the present-day era (2000-2006). Patients treated with total colectomy with ileostomy or proctocolectomy with ileal pouch were reviewed for outcome measures and practice setting (rural, urban non-teaching, urban teaching). Our main outcome measures were in-hospital mortality, length of stay, and total charges. Results: Total colectomy (n = 30,362) was performed five times more often than proctocolectomy (n = 6,085). When comparing the two study periods, mortality after total colectomy increased 3.8{\%} to 4.6{\%} (p = 0.0003). This difference was primarily due to increasing mortality in later years; when 1995-1996 was compared to 2005-2006, mortality increased from 3.6{\%} to 5.6{\%} (p <0.0001). There were no deaths in the proctocolectomy group (p <0.0001). The distribution by practice setting shifted over the two study periods, decreasing in rural (7.0{\%} to 4.8{\%}) and urban non-teaching (43.7{\%} to 28.4{\%}) centers, and increasing in urban teaching centers (49.3{\%} to 66.8{\%}). The total inflation-adjusted charges per patient increased significantly ($34,638 vs. $43,621; p <0.0001). Conclusions: The mortality rate after total colectomy is increasing, and the difference is accentuated in the years since widespread use of monoclonal antibody therapy. The care of these patients is being shifted to urban teaching centers and is becoming more expensive.",
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