Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome.

Background/aims: Approximately 20% of patients undergoing surgery for ulcerative colitis will retain their rectum. A single-stage proctocolectomy could be an appropriate procedure in patients who are definitely not candidates for a later restorative procedure, but it is generally not advised in acutely ill patients. The aim was to investigate the safety of one-stage proctocolectomy under elective and non-elective circumstances, with specific reference to identifying possible risk factors for postoperative complications.

Methods: A retrospective cohort study, including 54 consecutive patients undergoing proctocolectomy for ulcerative colitis. Out of these, 27 (50%) were admitted non-electively.

Results: Postoperative complications were observed in 30 patients (54%). Wound dehiscence, wound infection, and impaired perineal wound healing were observed in 10 (18.5%), 8 (14.8%), and 10 (18.5%) of the patients, respectively. There was no difference between elective and non-elective cases. Complications were observed more often in patients receiving high-dose corticosteroids (18/26 vs. 12/28; p = 0.06). Impaired perineal wound healing and reoperations were observed more often in the corticosteroid-treated group (8/26 vs. 2/28; p = 0.04 and 12/26 vs. 1/28; p = 0.0003).

Conclusions: Proctocolectomy is equally safe under elective and non-elective situations, but a preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.