The Surgical Epidemiology, Trials and Outcome Centre, St Mark's Academic Institute, London, UK.
Department of Surgery and Cancer, Imperial College, London, UK.
Aliment Pharmacol Ther. 2021 Feb;53(4):484-498. doi: 10.1111/apt.16202. Epub 2020 Dec 2.
Temporal trends in colectomy rate for ulcerative colitis (UC) are particularly relevant in the current era of published IBD standards and changing approach to salvage of acute severe disease.
To investigate temporal trends in colectomy for UC using English population data.
The Hospital Episode Statistics (HES) were interrogated between 2003-2016 with two patient groups investigated independently. An 'emergency' cohort: emergency UC admission ≥ three days, age ≥18 and a 'total population' cohort: all English patients undergoing colectomy for UC. Mixed methods analyses were utilised.
Emergency cohort: 37 981 patients, 49% female, median age 46. The one- and three-year incidence of colectomy after acute admission was 0.17 and 0.21. Interrupted time series (ITS) analysis suggested reductions in colectomy rate of 4% per year after 2008 at 30 and 90 days following emergency admission, with no significant reduction ≥1 year. Mortality and laparoscopy rates improved when avoiding colectomy at index and emergency admissions; however, the proportion of emergency colectomies after salvage at index admission significantly increased during the study period. Total population cohort: 17 580 patients underwent colectomy for UC between 2003 and 2016, demonstrating a 3.1% annual reduction in total and elective colectomies after 2008, but no reduction in emergency colectomies.
Reductions in short-term colectomy rates after emergency admission for UC do not persist beyond one year. Emergency colectomy rates remain unchanged. Reduced rates are probably due to multi-modal improvements in IBD care. A lack of data regarding disease severity precludes further interpretation of appropriate medical salvage and timely surgery.
在当前发布的炎症性肠病（IBD）标准和急性重度疾病治疗方法发生变化的时代，溃疡性结肠炎（UC）的结肠切除术率的时间趋势尤其重要。
使用英国人群数据调查 UC 结肠切除术的时间趋势。
2003 年至 2016 年期间，通过两种独立的患者组调查，对医院事件统计数据（HES）进行了询问。“急诊”队列：急诊 UC 入院≥3 天，年龄≥18 岁；“总人群”队列：所有因 UC 接受结肠切除术的英国患者。采用混合方法分析。
急诊队列：37981 例患者，49%为女性，中位年龄为 46 岁。急性入院后 1 年和 3 年的结肠切除率分别为 0.17 和 0.21。中断时间序列（ITS）分析表明，2008 年后，急诊入院后 30 天和 90 天的结肠切除术率每年下降 4%，但 1 年后无显著下降。在索引和急诊入院时避免结肠切除术可改善死亡率和腹腔镜检查率；然而，在研究期间，索引入院时的抢救后急诊结肠切除术的比例显著增加。2003 年至 2016 年间，17580 例患者因 UC 接受了结肠切除术，2008 年后，总结肠切除术和选择性结肠切除术的年发生率下降了 3.1%，但急诊结肠切除术的发生率没有下降。
UC 急诊入院后短期结肠切除术率的降低在 1 年后不会持续。急诊结肠切除术的比例保持不变。发生率的降低可能是由于 IBD 治疗的多模式改善。由于缺乏关于疾病严重程度的数据，无法进一步解释适当的医疗抢救和及时手术。
