Higher Surgical Morbidity for Ulcerative Colitis Patients in the Era of Biologics

Objective: To investigate differences in surgical approach and postoperative outcomes for patients with ulcerative colitis (UC) before and after the introduction of biologic therapy.

Background: Biologic use has dramatically increased since Food and Drug Administration approval of infliximab. Studies conflict as to the effect of these agents on surgical outcomes with some demonstrating worse surgical outcomes whereas others have found no difference.

Methods: We used an administrative, all-payer, all-age group database located in New York State. Patients were included if they had a diagnosis of UC and underwent surgery for their disease from 1995 to 2013. Outcomes were compared for the index admission, at 90-day, and 1-year follow up.

Results: A total of 7070 patients were included for analysis; 54% patients underwent surgery between 1995 and 2005 and the remaining 46% patients underwent surgery between 2005 and 2013. There was a significant increase in the proportion of patients who underwent at least 3 procedures after 2005(14% vs 9%, P < 0.01). On adjusted analysis, patients undergoing surgery after 2005 had higher likelihood of major events (odd s ratio, OR = 1.42; 95% confidence interval, CI = 1.13-1.78), procedural complications (OR = 1.42; 95% CI = 1.20-1.68), and nonroutine discharge (OR = 3.17; 95% CI = 2.79-3.60) during the index admission. Similar trends for worse adjusted outcomes in patients initially undergoing surgery after 2005 were seen at 90-day and 1-year follow up.

Conclusions: Since the introduction of biologic agents in 2005, surgery for patients with UC is more likely to require multiple procedures. Despite robust adjustments, patients having surgery recently have worse postoperative morbidity during the index hospitalization, at 90-day and 1-year follow up. More work is necessary to improve outcomes in these higher risk patients that undergo surgery.