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J Gastrointest Surg. 2018 Jan;22(1):124-132. doi: 10.1007/s11605-017-3530-y. Epub 2017 Aug 14.

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

Author information

1
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
2
Department of Surgery, McGill University, Montreal, Quebec, Canada.
3
Colorectal Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada.
4
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
5
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada. elham.rahme@mcgill.ca.
6
Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada. elham.rahme@mcgill.ca.
7
Elham Rahme, Center for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd. W Office 3E.12, Montreal, Quebec, H4A 3S5, Canada. elham.rahme@mcgill.ca.

Abstract

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.

KEYWORDS:

Biologics; Colectomy; Incidence; Predictors; Ulcerative colitis

PMID:
28808892
DOI:
10.1007/s11605-017-3530-y
[Indexed for MEDLINE]

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