What is the optimal timing of emergency colectomy for ulcerative colitis?

There is significant debate about the timing of emergency colectomy for patients with ulcerative colitis. In an effort to arrive upon an answer three of our Cleveland Clinic Florida Department of Colorectal Surgery alumni, Drs. Alodia Gabre-Kidan, Bashar Safar, and Jonathan Efron worked with four of their colleagues at their current institution, Johns-Hopkins University School of Medicine. The seven coauthors queried the American College of Surgeons National Surgical Quality Improvement Program database between 2005 and 2015. The authors were able to identify 508 patients who underwent total abdominal colectomy in the emergency for ulcerative colitis. After propensity matching the authors had a sample size of 573 patients, half of whom underwent colectomy within two days of admission. The two groups included “early” colectomy and “delayed” colectomy. The median time to performance of colectomy in the former group was one day as compared to six days in the latter group. The authors identified numerous benefits to early emergency colectomy including a mortality rate of 4.9% as compared to 20.3% in the matched delayed group and a complication rate of 64.5% versus 72% in the delayed group. Very importantly multivariate logistic regression with propensity weighting revealed that early surgery was related to an 82% decrease in the rate of death and 35% decrease in the risk of a complication as compared to patients who underwent delayed colectomy for colitis. Based upon these data the authors quite appropriately recommend proceeding to surgery without delays to optimize outcomes. I their words, “even short delays in surgical intervention once medical therapy has failed may be contributing to substantially worse postoperative outcomes”. I am very proud of our alumni, Drs. Gabre-Kidan, Safar, and Efron and congratulate them upon their important contribution to the literature.