Presented at the 2011 Tripartite Colorectal Meeting in Cairns, Queensland, Australia, 3–7 July 2011.
Surgical outcomes in steroid refractory acute severe ulcerative colitis: the impact of rescue therapy
Article first published online: 27 FEB 2013
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 3, pages 374–379, March 2013
How to Cite
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: 374–379. doi: 10.1111/j.1463-1318.2012.03188.x
- Issue published online: 27 FEB 2013
- Article first published online: 27 FEB 2013
- Accepted manuscript online: 31 JUL 2012 09:23AM EST
- Received 7 February 2012; accepted 1 May 2012; Accepted Article online 31 July 2012
- Acute colitis;
- rescue therapy;
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 10 days, 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 5 months, 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.