OC-165 No increase in surgical complication in patients treated with rescue therapy for acute severe ulcerative colitis: data from the UK IBD audit

Abstract

Conclusion (1) A distinct subset of miRNAs is deregulated in the mucosa of actively inflamed sigmoid UC in patients who are on no treatment. (2) Introduction High dose steroids followed by colectomy if required remains the mainstay of treatment for active ulcerative colitis (UC). Recently we have seen the introduction of second-line medical therapies with the hope of avoiding the need for surgery when medical therapy fails. Using a cohort of 2981 and 3049 ulcerative colitis patients from the 2nd and 3rd rounds of the UK IBD audit we aim to assess whether the use of second-line medical therapies has an impact on the need for surgery and complication of surgery when needed. Methods We audited 3049 patients with ulcerative colitis. Median age was 42; there were 1421 females and 1628 males. ). There were significantly more patients proceeding to surgery following anti-TNFa therapy in 2010 10.82% (17/157) vs 3.7% (6/163) (p<0.008). Using the Travis criteria we also found that there were significantly less high risk surgical patients in 2010, 67.5% (106/157) compared to 83.4% (136/163) (p<0.002); this was also reflected in a significant reduction in the overall amount of high risk patients in the ASUC population. Post-operative complications are not statistically different between patients who did and did not receive rescue medical therapy 40.0% (26/65) vs 34.8% (32/92) (p<0.8). There was also no statistical difference in complications between rounds, 32.5% (53/163) in 2008 vs 36.9% (58/157) in 2010 (p<0.4). Conclusion The surgical rate has remained the same over the two audit periods; however there has been a significant reduction in the proportion of high risk patients undergoing operations. This could in part be related to the increased use of second line medical therapies between the two audit rounds, with significantly more patients receiving anti-TNFa prior to surgery. The use of second line medical therapies did not increase the risk of surgery.

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

“…Participation in the Audit was a catalyst for service improvement 1231. Monitoring and reporting adverse events are important aspects of service improvement 1232 1233…”

Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262): clinical effectiveness systematic review and economic model

“…Perioperative mortality rates were taken from the third round of the UK IBD audit. 146 Within the 2012 publication of the UK IBD audit, there were 28 deaths reported among 807 elective and emergency surgical episodes in adult patients with UC; a probability of death of 0.03 is assumed within the cycle in which the patient undergoes surgery. Other-cause mortality was modelled according to age-and sex-specific life tables from the Office for National Statistics.…”

Letter: acute severe ulcerative colitis - should all patients be treated equally? Authors' reply

“…7 However, it is important to emphasise that our follow-up extends only to hospital discharge. The cornerstone of high-quality care in ASUC continues to be a multidisciplinary approach, with decisions being made promptly and with the appropriate involvement of all members, including patients.…”