Surgical outcomes in steroid refractory acute severe ulcerative colitis: the impact of rescue therapy

Powar, M. P., Martin, P., Croft, A. R., Walsh, A., Petersen, D., Stevenson, A. R. L., Lumley, J. W., Stitz, R. W., Radford-Smith, G. L. and Clark, D. A. (2013) Surgical outcomes in steroid refractory acute severe ulcerative colitis: the impact of rescue therapy. Colorectal Disease, 15 3: 374-379. doi:10.1111/j.1463-1318.2012.03188.x


Author Powar, M. P.
Martin, P.
Croft, A. R.
Walsh, A.
Petersen, D.
Stevenson, A. R. L.
Lumley, J. W.
Stitz, R. W.
Radford-Smith, G. L.
Clark, D. A.
Title Surgical outcomes in steroid refractory acute severe ulcerative colitis: the impact of rescue therapy
Journal name Colorectal Disease   Check publisher's open access policy
ISSN 1462-8910
1463-1318
Publication date 2013-03
Sub-type Article (original research)
DOI 10.1111/j.1463-1318.2012.03188.x
Volume 15
Issue 3
Start page 374
End page 379
Total pages 6
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell
Collection year 2014
Language eng
Formatted abstract
Aim: The advent of rescue medical therapy (cyclosporin or infliximab) and laparoscopic surgery has shifted the paradigm in managing steroid refractory acute severe ulcerative colitis (ASUC). We investigated prospectively the impact of rescue therapy on timing and postoperative complications of urgent colectomy and subsequent restorative surgery for steroid refractory ASUC.

Method: All consecutive presentations of steroid refractory ASUC at the Royal Brisbane Hospital (1996-2009) were entered in the study. Data collated included demographics, clinical and laboratory parameters on admission, medical therapy and operative and postoperative details. Steroid refractory ASUC patients undergoing immediate colectomy were compared with those failing rescue therapy and requiring same admission colectomy.

Results: Of 108 steroid refractory ASUC presentations, 19 (18%) received intravenous steroids only and proceeded directly to colectomy. Rescue medical therapy was instituted in 89 (82%) patients with 30 (34%) failing to respond and proceeding to colectomy. There was no significant difference in the median time from admission to colectomy for rescue therapy compared with steroid-only cases (12 vs 10days, P=0.70) or 30-day complication rates (27%vs 47%, P=0.22). The interval from colectomy to a subsequent restorative procedure was significantly longer for patients who failed rescue therapy (12 vs 5months, P=0.02). Furthermore 30-day complications following pouch surgery were significantly higher in patients who failed rescue therapy (32%vs 0%, P=0.01).

Conclusion:
Rescue therapy in steroid refractory ASUC is not related to delay in urgent colectomy or increased post-colectomy complications.
Keyword Acute colitis
Rescue therapy
Colectomy
Complications
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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