SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2018/07  
 
  2018 Jul;113(7):1009-1016.  
  doi: 10.1038/s41395-018-0057-0.  
 
  Post-Operative Morbidity and Mortality of a Cohort of Steroid Refractory Acute Severe Ulcerative Colitis : Nationwide Multicenter Study of the GETECCU ENEIDA Registry  
 
  Ordás I, Domènech E, Mañosa M, García-Sánchez V, Iglesias-Flores E, Rodríguez-Moranta F, Márquez L, Merino O, Fernández-Bañares F, Gomollón F, Vera M, Gutiérrez A, LLaó J, Gisbert JP, Aguas M, Arias L, Rodríguez-Lago I, Muñoz C, Alcaide N, Calvet X, Rodríguez C, Montoro MA, García S, De Castro ML, Piqueras M, Pareja L, Ribes J, Panés J, Esteve M; ENEIDA registry of GETECCU.  
  https://www.ncbi.nlm.nih.gov/pubmed/29713028  
 
 

Abstract
 

BACKGROUND:

Despite the increased use of rescue medical therapies for steroid refractory acute severe ulcerative colitis, mortality related to this entity still remains high. We aimed to assess the mortality and morbidity related to colectomy and their predictive factors in steroid refractory acute severe ulcerative colitis, and to evaluate the changes in mortality rates, complications, indications of colectomy, and the use of rescue therapy over time.

METHODS:

We performed a multicenter observational study of patients with steroid refractory acute severe ulcerative colitis requiring colectomy, admitted to 23 Spanish hospitals included in the ENEIDA registry (GETECCU) from 1989 to 2014. Independent predictive factors of mortality were assessed by binary logistic regression analysis. Mortality along the study was calculated using the age-standardized rate.

RESULTS:

During the study period, 429 patients underwent colectomy, presenting an overall mortality rate of 6.3% (range, 0-30%). The main causes of death were infections and post-operative complications. Independent predictive factors of mortality were: age ≥50 years (OR 23.34; 95% CI: 6.46-84.311; p < 0.0001), undergoing surgery in a secondary care hospital (OR 3.07; 95% CI: 1.01-9.35; p = 0.047), and in an emergency setting (OR 10.47; 95% CI: 1.26-86.55; p = 0.029). Neither the use of rescue medical treatment nor the type of surgical technique used (laparoscopy vs. open laparotomy) influenced mortality. The proportion of patients undergoing surgery in an emergency setting decreased over time (p < 0.0001), whereas the use of rescue medical therapy prior to colectomy progressively increased (p > 0.001).

CONCLUSIONS:

The mortality rate related to colectomy in steroid refractory acute severe ulcerative colitis varies greatly among hospitals, reinforcing the need for a continuous audit to achieve quality standards. The increasing use of rescue therapy is not associated with a worse outcome and may contribute to reducing emergency surgical interventions and improve outcomes.

 
Question posée
 
Quelle est la morbidité et la mortalité de la colectomie indiquée pour colite aigüe grave ? Quels sont les facteurs prédictifs de l’évolution ?
 
Question posée
 
- La mortalité était de 6,3%, principalement liée à des infections et des complications post opératoires. - Les facteurs de risque indépendants étaient l’âge ≥50 ans, la chirurgie en urgence et la chirurgie faite dans un centre secondaire. - La proportion d’interventions chirurgicales en urgence pour colite réfractaire diminue avec le temps.
 
Commentaires

Etude multicentrique espagnole conduite par le GETECCU soulignant une nouvelle fois la nécessité de prise en charge des patients en colite aigüe grave dans un centre ayant une expertise dans les MICI.

 
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