Reducing rate of total colectomies for ulcerative colitis but higher morbidity in the biologic era: an 18-year linked data study from New South Wales Australia

BackgroundThis study aims to investigate the trends in UC surgery in New South Wales (NSW) at a population level.MethodsA retrospective data linkage study of the NSW population was performed. Patients of any age with a diagnosis of UC who underwent a total abdominal colectomy (TAC) +/- proctectomy between Jul-2001 and Jun-2019 were included. The age adjusted population rate was calculated using Australian Bureau of Statistics data. Multivariable linear regression modelled the trend of TAC rates, and assessed the effect of infliximab (listed on the Pharmaceutical Benefits Scheme for UC in Apr-2014).ResultsA total of 1365 patients underwent a TAC +/- proctectomy (mean age 47.0 years (+/- 18.6), 59% Male). Controlling for differences between age groups, the annual rate of UC TACs decreased by 2.4% each year (95% CI 1.4%-3.4%) over the 18-year period from 1.30/100000 (2002) to 0.84/100000 (2019). An additional incremental decrease in the rate of TACs was observed after 2014 (OR 0.83, 95% CI 0.69-1.00). There was no change in the proportion of TACs performed emergently over the study period (OR 1.02, 95% CI 0.998-1.04). The odds of experiencing any perioperative surgical complication (aOR 1.54, 95% CI 1.01-2.33, P = 0.043), and requiring ICU admission (aOR 1.85, 95% CI 1.24-2.76, P = 0.003) significantly increased in 2014-2019 compared to 2002-2007.ConclusionsThe rate of TACs for UC has declined over the past two decades. This rate decrease may have been further influenced by the introduction of biologics. Higher rates of complications and ICU admissions in the biologic era may indicate poorer patient physiological status at the time of surgery. The rate of total (procto)colectomies for ulcerative colitis has declined over the past two decades in NSW. This rate decrease may have been further influenced by the introduction of biologics onto the PBS in 2014. Higher rates of complications and ICU admissions in the biologic era may indicate poorer patient physiological status at the time of surgery.image

Automated summary

This study aims to investigate the trends in total abdominal colectomy (TAC) rates for ulcerative colitis (UC) in New South Wales (NSW). The study found that the rate of TACs has decreased over the past two decades, which may have been influenced by the introduction of biologics. However, in the biologic era, there were higher rates of complications and ICU admissions, suggesting poorer patient physiological status at the time of surgery.