Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis.

BACKGROUND

Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC.

OBJECTIVE

The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion.

DESIGN

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses.

SETTING

The ACS NSQIP database from 2013 to 2016 was evaluated.

PATIENTS

Adult patients undergoing nonelective, nonemergency colectomy for UC.

MAIN OUTCOME MEASURES

30-day morbidity and mortality.

RESULTS

921 patients underwent urgent inpatient surgery for UC. In univariate analysis, there was no significant difference between prompt and delayed surgery for wound infection, sepsis, return to operating room, or readmission.

LIMITATIONS

Retrospective study of a quality improvement database. Patients who underwent successful MRT did not receive surgery, so are not included in the database.

CONCLUSIONS

Delaying surgery to further attempt MRT does not alter short-term outcomes and may allow conversion to elective future surgery. Contrarily, medical optimization does not improve short-term outcomes.