Total colectomy for ulcerative colitis in children: when are we operating?

• Published in: Pediatric surgery international 2013-07, Vol.29 (7), p.689-696
• Main Authors: McAteer, Jarod P., Larison, Cindy, Wahbeh, Ghassan T., Kronman, Matthew P., Goldin, Adam B.
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones; Anemia - complications; Child; Child, Preschool; Clostridium Infections - complications; Cohort Studies; Colectomy - methods; Colectomy - statistics & numerical data; Colitis, Ulcerative - complications; Colitis, Ulcerative - surgery; Databases, Factual - statistics & numerical data; Disease Progression; Female; Hospitalization - statistics & numerical data; Humans; Infant; Infant, Newborn; Male; Malnutrition - complications; Medicine; Medicine & Public Health; Odds Ratio; Original Article; Parenteral Nutrition, Total - statistics & numerical data; Pediatric Surgery; Pediatrics; Retrospective Studies; Risk Factors; Surgery; United States; Water-Electrolyte Balance
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-013-3307-7

Purpose Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients. Methods We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy. Results Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08). Conclusion These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.