Incidence Rates and Predictors of Colectomy for Ulcerative Colitis in the Era of Biologics: Results from a Provincial Database

• Published in: Journal of gastrointestinal surgery 2018, Vol.22 (1), p.124-132
• Main Authors: Abou Khalil, Maria, Boutros, Marylise, Nedjar, Hacene, Morin, Nancy, Ghitulescu, Gabriela, Vasilevsky, Carol-Ann, Gordon, Philip, Rahme, Elham
• Format: Article
• Language: English
• Subjects: 2017 SSAT Plenary Presentation; Adult; Age Factors; Aged; Anemia; Anemia - epidemiology; Biological Products - therapeutic use; Colectomy - statistics & numerical data; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - mortality; Colitis, Ulcerative - surgery; Colon; Emergencies - epidemiology; Female; Gastroenterology; Gastrointestinal surgery; Health risk assessment; Heart failure; Heart Failure - epidemiology; Hospitalization; Humans; Inflammatory bowel disease; Interrupted Time Series Analysis; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Proportional Hazards Models; Quebec - epidemiology; Risk Factors; Sex Factors; Surgery
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-017-3530-y

Background We evaluated long-term incidence and identified risk factors of colectomy in pre-biologics and biologics eras for treatment of ulcerative colitis. Methods After IRB approval, using data obtained from the Régie d’assurance maladie du Québec, we defined two cohorts: pre-biologics (1998–2004) and biologics (2005–2011) eras. Patients with inflammatory bowel disease or colectomy 1 year prior to first diagnosis of ulcerative colitis were excluded. Multivariate logistic regression model compared patient baseline characteristics. Kaplan-Meier curves displayed unadjusted time to event. Cox proportional hazards models were used to compare adjusted colectomy and mortality rates, respectively. Results In pre-biologics and biologics eras, 335/2829 and 314/3313 patients, respectively, underwent colectomy. Median follow-up (first and third quartiles) was similar ( p  = 0.206). Incidence rates for colectomy were 36.08/1000 and 29.99/1000 patient years. Unadjusted rate of colectomy was higher in pre-biologics era ( p =  0.004). Predictors of colectomy included anemia (1.66; 1.38–2.01), gastrointestinal hospitalizations (1.24; 1.04–1.47), congestive heart failure (2.08; 1.27–3.40), and male gender (1.47; 1.26–1.72). Mortality was 8.06 and 3.18% in pre-biologics and biologics eras. After adjusting for potential confounders, age (1.08; 1.05–1.12) and urgent colectomy (5.65; 2.19–14.54) remained associated with increased mortality hazard. Conclusion Incidence of colectomy decreased after introduction of biologics. Risk factors for colectomy were gastrointestinal hospitalizations, anemia, male gender, and congestive heart failure. Emergent surgery and age were predictors of mortality.