eP248 - Surgical Treatment of Ulcerative Colitis: Does Delay in Referral Lead to Worse Outcomes?

Purpose/Background: With the push for organ preservation in patients with ulcerative colitis (UC) in the modern era of medical polypharmacy, there may be a detrimental delay in surgical referral and definitive surgical treatment. The purpose of this study was to evaluate patients with UC undergoing emergent colectomy due to failed medical therapy and to evaluate which of these patients had preoperative surgical consultations.Methods/Interventions: We retrospectively queried the electronic medical record database at a single, tertiary-care institution for patients that underwent any proctectomy or colectomy associated with ulcerative colitis between January 2022 and October 2023. Medial therapy was defined as >/ 1 year of biologic therapy prior to surgery, and fulminant UC was defined as perforation, shock, and/ or peritonitis at the time of admission. Data was collected on patient characteristics, age at UC diagnosis, setting of surgery, and the surgical outcomes. Characteristics were compared between presentation groups: (1) fulminant colitis requiring emergent surgery, (2) fulminant colitis requiring emergent surgery currently on medial therapy, and (3) elective surgical resection without fulminant presentation.Results/Outcomes: In total, 147 patients were identified, 79 patents were excluded as they did not have clinical, radiographic or pathologic finings of UC. Of the remaining 68 patients, the mean age was 41 years (SD 18) and 57% were males. Mean time from diagnosis of UC to evaluation by a colorectal surgeon was 8 years (SD 9). Overall, 29 (43%) of UC patients developed fulminant colitis requiring emergent surgery. Of these 29 emergent colectomies, 14 (48%) patients were actively undergoing outpatient medical therapy but were never evaluated by a surgeon prior to their emergent admission and colectomy. A total abdominal colectomy with end-ileostomy was the most common index emergent operation in 27 (93%) of patients. Overall, the median length of follow-up was 1.2 years (IQR 0.7-2.0). The overall complication rate was 34% and the mean length of stay 9 days (SD 6). Overall, statistically significant differences between the fulminant emergent surgical group and elective surgical group were seen in the risks of perforation (27.6% v 0%), and any surgical complication rates (55.2% v 17.9%). Patient characteristics that were most common in the delayed referral group were older age, female gender, chronic steroid use and frequent loss to clinic follow-up.Conclusion/

Discussion: In our study, almost half of patients undergoing an emergent colectomy for ulcerative colitis were under long-term medical therapy but were never evaluated by a surgeon prior to surgery. We believe that surgical consultation is an important part of the pre-surgical treatment team in patients with ulcerative colitis and elective surgical consultation is an opportunity for improvement in the care of UC patients.Table 1. Baseline Characteristics and Outcomes of Patient Cohort