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. 2007 Nov 17;335(7628):1033.
doi: 10.1136/bmj.39345.714039.55. Epub 2007 Oct 30.

Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies

Stephen E Roberts  1 , John G Williams, David Yeates, Michael J Goldacre
Affiliations

Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies

Stephen E Roberts et al. BMJ. .

Abstract

Objective: To compare mortality outcomes in the three years after elective colectomy, no colectomy, and emergency colectomy among people admitted to hospital for inflammatory bowel disease, to inform whether the threshold for elective colectomy in clinical practice is appropriate.

Design: Record linkage studies.

Setting: Oxford region (1968-99) and England (1998-2003).

Participants: 23,464 people with hospital stay for more than three days for inflammatory bowel disease, including 5480 who had colectomy.

Main outcome measures: Case fatality, relative survival, and standardised mortality ratios.

Results: In the Oxford region, three year mortality was lower after elective colectomy than after either no colectomy or emergency colectomy, although this was not significant. For England, mortality three years after elective colectomy for ulcerative colitis (3.7%) and Crohn's disease (3.3%) was significantly lower than that after either admission without colectomy (13.6% and 10.1%; both P<0.001) or emergency colectomy (13.2% and 9.9%; P<0.001 for colitis and P<0.01 for Crohn's disease). Three or more months after elective colectomy, mortality was similar to that in the general population. Adjustment for comorbidity did not affect the findings.

Conclusions: In England, the clinical threshold for elective colectomy in people with inflammatory bowel disease may be too high. Further research is now required to establish the threshold criteria and optimal timing of elective surgery for people with poorly controlled inflammatory bowel disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Relative survival during three years after elective colectomy, emergency colectomy, or no colectomy in Oxford region (1968-96) for patients admitted with ulcerative colitis and for Crohn's disease, adjusted for age and sex and compared with general population. Survival in general population is 1. Slight ascent of survival curves is largely due to small numbers of surgical cases
None
Fig 2 Relative survival during three years after elective colectomy, emergency colectomy, and no colectomy in England (1998-2000) for patients admitted for ulcerative colitis and for Crohn's disease, adjusted for age and sex and compared with general population. Survival in general population is 1. Shaded areas are 95% confidence intervals
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Comment in

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