Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: a population-based nationwide cohort study

Abstract

Objectives

The purpose of this investigation was to assess 30-day mortality among Danish inflammatory bowel diseases (IBD) patients and to examine the prognostic impact of hospital total colectomy volume, age, gender and comorbidity.

Design

Cohort study.

Setting

The authors compared 30-day survival over the period 1996–2010 among 2889 IBD patients with total colectomy identified in the Danish National Registry of Patients. This registry covers all hospitals in Denmark. Postoperative survival patterns for patients with ulcerative colitis and Crohn's disease were compared, using proportional hazard regression. The regression model accounted for the timing of surgery, hospital total colectomy volume, age, gender and comorbidity.

Participants

Patients were enrolled in the study if they had a hospital registry diagnosis of IBD, with accompanying procedure codes for total colectomy (see codes in online appendix table 1). Hospitalisations were described as elective or emergency, and patients were categorised as having Crohn's disease, ulcerative colitis or as a mixed group.

Outcome measures

Primary outcome measure was 30-day mortality.

Results

Among 2889 IBD patients with total colectomy, 1439 (50%) underwent surgery during an emergency hospitalisation. Thirty-day mortality was 5.3% (76/1439) among emergency cases compared with 1% (14/1450) among elective cases. The highest mortality (8.1%; 11 of 136) was observed among Crohn's patients undergoing emergency surgery. The mortality of patients with ulcerative colitis undergoing emergency surgery was 5.2% (55/1056). After elective surgery, the 30-day mortality was 0.9% (8/938) among patients with ulcerative colitis and 1.5% (3/201) among Crohn's disease patients. Low hospital total colectomy volume, comorbidity and high age were associated with increased 30-day mortality in ulcerative colitis patients undergoing emergency surgery.

Conclusion

Emergency total colectomy among patients with ulcerative colitis and particularly Crohn's disease is associated with substantial 30-day mortality.

Article summary

Article focus

• Elective and emergency total colectomy is commonly performed in inflammatory bowel disease.

• Emergency operations are associated with higher mortality than elective procedures.

Key messages

• IBD patients undergoing emergency total colectomy have a 30-day mortality of 5.3% as opposed to 1% after elective total colectomy.

• Low hospital volume, high age and comorbidity are associated with increased mortality in patients with ulcerative colitis undergoing emergency surgery.

• It is suggested to centralise treatment, and to aim for elective procedures in high-risk patients.

Strengths and limitations of this study

• The study covers complete national data on total colectomies performed for inflammatory disease.

• The unique ID number of all patients makes recording of all events highly reliable.

• The main limitation is lack of access to specific clinical parameters.