Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital and Academic Institute, Harrow, Middlesex, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Colorectal Dis. 2018 Sep;20(9):804-812. doi: 10.1111/codi.14113. Epub 2018 Apr 19.
A longstanding disparity exists between the approaches to restorative surgery after colectomy for patients with ulcerative colitis (UC) in England and Sweden. This study aims to compare rates of colectomy and restorative surgery in comparable national cohorts.
The English Hospital Episode Statistics (HES) and Swedish National Patient Register (NPR) were interrogated between 2002 and April 2012. Patients with two diagnostic episodes for UC (age ≥ 15 years) were included. Patients were excluded if they had an episode of inflammatory bowel disease or colectomy before 2002. The cumulative incidences of colectomy and restorative surgery were calculated using the Kaplan-Meier method.
A total of 98 691 patients were included in the study, 76 129 in England and 22 562 in Sweden. The 5-year cumulative incidence of all restorative surgery after colectomy in England was 33% vs 46% in Sweden (P-value < 0.001). Of the patients undergoing restorative surgery, 92.3% of English patients had a pouch vs 38.8% in Sweden and 7.7% vs 59.1% respectively had an ileorectal anastomosis (IRA). The 5-year cumulative incidence of colectomy in this study cohort was 13% in England and 6% in Sweden (P-value < 0.001).
Following colectomy for UC only one-third of English patients and half of Swedish patients underwent restorative surgery. In England nearly all these patients underwent pouches, in Sweden a less significant majority underwent IRAs. It is surprising to demonstrate this discrepancy in a comparable cohort of patients from similar healthcare systems. The causes and consequences of this international variation in management are not fully understood and require further investigation.
在英国和瑞典，溃疡性结肠炎（UC）患者行结肠切除术后的修复手术方法存在长期差异。本研究旨在比较可比国家队列中结肠切除术和修复手术的比率。
2002 年至 2012 年 4 月期间，对英国的医院事件统计（HES）和瑞典国家患者登记处（NPR）进行了调查。纳入了两次 UC 诊断发作（年龄≥15 岁）的患者。如果患者在 2002 年前有过炎症性肠病或结肠切除术发作，则将其排除在外。使用 Kaplan-Meier 方法计算结肠切除术和修复手术的累积发生率。
本研究共纳入 98691 例患者，其中 76129 例来自英国，22562 例来自瑞典。英国结肠切除术后所有修复手术的 5 年累积发生率为 33％，而瑞典为 46％（P 值<0.001）。在接受修复手术的患者中，英国患者中有 92.3％接受了袋状手术，而瑞典患者中这一比例为 38.8％，分别有 7.7％和 59.1％的患者接受了回肠直肠吻合术（IRA）。在本研究队列中，英国结肠切除术的 5 年累积发生率为 13％，瑞典为 6％（P 值<0.001）。
在 UC 患者行结肠切除术后，只有三分之一的英国患者和一半的瑞典患者接受了修复手术。在英国，几乎所有这些患者都接受了袋状手术，而在瑞典，接受 IRA 的患者则较少。在来自相似医疗保健系统的可比患者队列中，证明存在这种差异令人惊讶。这种管理方面的国际差异的原因和后果尚未完全了解，需要进一步调查。
