Surgical Outcomes in Steroid Refractory Acute Severe Ulcerative Colitis: The Impact of Rescue Therapy
Colorectal Disease, 08/01/2012
Powar MP et al. – Rescue therapy in steroid refractory acute severe ulcerative colitis (ASUC) is not related to delay in urgent colectomy or increased post–colectomy complications.Methods
- All consecutive presentations of steroid refractory ASUC to 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 post-operative details.
- Steroid refractory ASUC patients undergoing immediate colectomy were compared with those failing rescue therapy and requiring same admission colectomy.
- 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 v 10 days p=0.70) or 30-day complication rates (27 v 47% p=0.22).
- The interval from colectomy to a subsequent restorative procedure was significantly longer for patients who failed rescue therapy (12 v 5 months, p=0.02).
- Furthermore 30-day complications following pouch surgery were significantly higher in patients who failed rescue therapy (32 v 0%, p=0.01).