Short‐term outcomes following total colectomy for inflammatory bowel disease in Denmark after implementation of laparoscopy: a nationwide population‐based study

Abstract

AimA laparoscopic approach to total colectomy (TC) for inflammatory bowel disease (IBD) is being increasingly used, but data on its comparative benefits over open TC are conflicting. The aim of this study was to examine 90‐day outcomes following laparoscopic and open TC for IBD in a nationwide cohort after the introduction of laparoscopy.MethodIBD patients undergoing TC in Denmark from 2005 to 2017 were identified from the Danish National Patient Registry. We used Kaplan–Meier methodology to estimate mortality and Cox regression analysis to estimate adjusted mortality rate ratios (aMRRs) and adjusted hazard ratios (aHRs) of reoperation, readmission and intensive care unit (ICU) transfer, comparing patients undergoing laparoscopic versus open TC.ResultsWe identified 1095 patients undergoing laparoscopic TC and 1523 patients undergoing open TC. Following emergency TC, 90‐day mortality was 2.8% (1.6%–4.9%) after laparoscopic TC and 9.1% (7.0%–11.8%) after open TC. Ninety‐day mortality was 0.9% (0.3%–2.5%) after laparoscopic TC and 2.6% (1.5%–4.3%) after open elective TC. The aMRRs associated with laparoscopic TC were 0.45 (95% CI 0.25–0.80) in emergency cases and 0.29 (95% CI 0.10–0.86) in elective cases. Risks of readmission were comparable following laparoscopic versus open TC, both in emergency [aHR = 0.93 (95% CI 0.76–1.15)] and elective [aHR = 0.83 (95% CI 0.68–1.02)] cases, while risks of ICU transfer and reoperation were lower following laparoscopic TC, both in emergency cases [aHR = 0.53 (95% CI 0.35–0.82) and aHR = 0.26 (95% CI 0.15–0.47)] and elective [aHR = 0.58 (95% CI 0.35–0.95) and aHR = 0.37 (95% CI 0.21–0.66)] cases.ConclusionThe introduction of laparoscopic TC for IBD in Denmark was not associated with increased mortality or morbidity. In fact, laparoscopic TC for IBD may be associated with lower short‐term mortality and morbidity compared with open TC.

Contemporary perioperative outcomes after total abdominal colectomy for ulcerative colitis in a tertiary referral centre

“…When examining elective UC cases as well (n = 168), 85.7% (n = 144) of colectomies were performed for refractory disease, and 7.1% (n = 12) for dysplasia or malignancy. This largely mirrors the international literature, where refractory disease accounts for 61.2-77.6% of IBD colectomies [10,18,19], and neoplasia 2-7.6% [10,12,18,19].…”

“…Mortality after IBD colectomy is significant, ranging from 0.2 to 4.9% [12,20], with reports of as high as 8.1% [3]. Likewise, morbidity is substantial at over 30%, with post-operative sepsis, wound infection, venous thromboembolism, and post-operative transfusion being common [10,21].…”

“…The choice of operation depends on underlying pathology, patient physiology, timing of surgery, patient preference, and surgical assessment. Mortality rates after colectomy vary significantly between cohorts ranging from <1% to 4.9%, with substantial associated morbidity of 30-40% [10][11][12]. In tandem with improvements in medical therapy, the introduction of laparoscopic surgery has improved short term outcomes, with less associated morbidity, fewer surgical sites infections, and shorter length of stay (LOS) [10,12].…”

“…Mortality rates after colectomy vary significantly between cohorts ranging from <1% to 4.9%, with substantial associated morbidity of 30-40% [10][11][12]. In tandem with improvements in medical therapy, the introduction of laparoscopic surgery has improved short term outcomes, with less associated morbidity, fewer surgical sites infections, and shorter length of stay (LOS) [10,12]. This single centre, retrospective cohort study examines perioperative outcomes after emergency total abdominal colectomy (TAC) with end ileostomy for consecutive UC patients.…”

Rates of Adverse Events in Patients With Ulcerative Colitis Undergoing Colectomy During Treatment With Tofacitinib vs Biologics: A Multicenter Observational Study

“…The type of surgery also impacts the outcome of colectomy. Laparoscopic surgery offers a reduced risk of short-term complications, incisional hernias, and adhesions ( 31 – 33 ). On the other hand, there are conflicting data regarding the superiority of a 3-stage vs 1- or 2-stage approach in terms of postoperative complications ( 34 – 36 ), with international guidelines suggesting to prefer a 3-stage approach in patients under steroids or biologics and to avoid one stage approach in patients receiving anti-TNFs ( 37 ).…”