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 23 January 2018

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News

Threshold for bowel surgery may be too high, warn experts

Experts compare mortality with and without colectomy in hospital admissions for ulcerative colitis and Crohn's disease, reports the BMJ ahead of print.

News image

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Inflammatory Bowel Disease (IBD) is a general term for chronic inflammation of the intestine and includes ulcerative colitis and Crohn's disease.

Around a quarter of a million people in the UK are affected and many people will require colectomy at some stage.

Currently there are about 2,000 total or partial colectomies performed each year in England for IBD.

Death rates following elective colectomy are typically quite low, at least in the short term, while delaying surgery carries increased risks.

It is preferable for colectomy to be undertaken electively
British Medical Journal

It is thought, increasingly, that the thresholds for elective colectomy may be too high.

However, there is a lack of strong evidence about this.

Dr Stephen Roberts from the United Kingdom used routinely collected hospital data throughout England to investigate mortality after colectomy for IBD.

The team compared those who underwent elective colectomy, with emergency colectomy, or who were hospitalized for IBD but had no colectomy.

The researchers evaluated 23,464 people who were hospitalized for more than 3 days for IBD, 5,480 of whom underwent colectomy.

The team traced all deaths up to 3 years after hospital admission.

The research team found improved long term survival for elective colectomy compared with emergency colectomy or no colectomy.

The researchers also confirmed a substantially increased risk of dying shortly after emergency colectomy.

At 3 years, the increased of risk of death in people who did not undergo colectomy was almost as high as that in people who underwent emergency colectomy.

In contrast, the team observed that survival among people who underwent elective colectomy was very similar to that in the general population.

Dr Roberts' team commented, "Our study findings suggest that the threshold for elective colectomy for IBD in England is too high."

"It also illustrates that, whenever indicated and possible, it is preferable for colectomy to be undertaken electively, rather than risk the need for emergency surgery when it has a much poorer prognosis."

"We believe that further research is now required to establish the threshold criteria and optimal timing for colectomy in people with poorly controlled IBD."

"The idea that surgery for IBD should be the last resort is flawed", adds an accompanying editorial in the British Medical Journal.

"These findings, even allowing for interpretation, should be a word of caution to those who promote it."

BMJ 2007: EMBARGOED until 00:01 GMT
31 October 2007

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