Background
The incidence of ulcerative colitis (UC) is increasing, but there are few reports comparing elderly UC patients undergoing colectomy for elderly-onset UC (EOUC) and nonelderly-onset UC (NEOUC). The aim of this study was to analyze the differences between EOUC and NEOUC patients who underwent UC-related surgery.
Methods
We identified 1973 patients with UC who underwent colectomy at Hyogo College of Medicine between January 1, 1984, and December 31, 2018. Only patients aged 65 years old and older who underwent colectomy were enrolled in this study (n=221, 11.2%), and their clinical records were retrospectively reviewed. Patients were divided into two groups according to their age at disease onset: those with onset at younger than 60 years old (NEOUC) and at 60 years old or older (EOUC).
Results
In the 221 UC patients who underwent colectomy at 65 years old or older, there were 155 cases of EOUC and 66 cases of NEOUC. The main surgical indication in NEOUC patients was colitis-associated cancer/dysplasia (32/66, 47%). In contrast, refractory to medical treatment was the leading cause of surgery in EOUC patients (80/155, 52%). The distributions of surgical indications were different between the two groups (p<0.01).
The preoperative daily dose of steroids was significantly higher in the EOUC group than in the NEOUC group (0 mg vs 10 mg, p<0.01). The rates of immunosuppressant, infliximab (IFX) and adalimumab use did not differ significantly between the groups. Significantly more patients underwent emergency surgery in the EOUC group than in the NEOUC group (14% vs 35%, p<0.01).
The proportions of patients with postoperative morbidity (Clavien-Dindo grade III or higher) were 17.4% (27/155) in the EOUC group and 13.6% (9/66) in the NEOUC group. There was no significant difference between the two groups (p=0.48). The prognosis of the EOUC patients who underwent UC-related emergency surgery was worse than that of the NEOUC patients (p<0.01). In the EOUC group, 8 (14.8 %) of 54 patients died within 30 postoperative days, while there were no deaths in the NEOUC group.
Conclusion
Among elderly UC patients undergoing UC-related surgery, EOUC patients undergoing emergency surgery had very poor outcomes, and the mortality rate was 14.8%. In such cases, it is important for physicians and surgeons to begin communication at an early stage so that the optimal surgical timeframe is not missed.