The researchers investigated the changes in indications for surgery for ulcerative colitis in elderly patients, over the last four decades.
The findings of the study were published in the December issue of the Archives of Surgery.
The medical records of all patients 65 years and older, who underwent surgery for ulcerative colitis during a 40-year period, were analyzed retrospectively.
A total of 113 patients who underwent surgery between 1 January 1960 and 30 June 1999 were identified.
The patients were divided into 3 cohorts of 38, 38, and 37 consecutive patients admitted to the hospital during the periods 1960 through 1984, 1985 through 1993, and 1994 through 1999, respectively.
The team found that indications for surgery, and morbidity and mortality rates have changed with time.
|Predictors of poor outcome:|
- Male sex
- Albumin level 2.8 g/dl or less
- Urgent procedures
| Archives of Surgery |
Dysplasia has replaced carcinoma as a major indication for elective surgery.
It was found that toxic megacolon has become significantly less common as an indication for urgent surgery.
Surgery-associated adverse outcomes have decreased significantly from 50% (13% deaths, 37% major complications) to 27% (3% deaths, 24% major complications).
Male sex, an albumin level of 2.8 g/dl or less, and urgent surgery were found to be independent predictors of poor outcome.
Dr Gidon Almogy, of the Mount Sinai Hospital and the Mount Sinai School of Medicine, New York, commented on behalf of the group, "In our referral center, the indications for urgent and elective surgery have changed during the past 4 decades. These have moved from toxic megacolon and carcinoma, to disease refractory, to medical therapy and dysplasia, respectively."
"Morbidity and mortality have decreased dramatically over time. Urgent procedures, low levels of albumin, and male sex are all predictors of poor outcome," it was concluded.