Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis

Gastroenterology. 2008 Mar;134(3):680-7. doi: 10.1053/j.gastro.2008.01.004. Epub 2008 Jan 10.


Background & aims: Postoperative morbidity and mortality following a colectomy for ulcerative colitis (UC) has been primarily reported from tertiary care referral centers that perform a high volume of operations; however, the postoperative outcomes among nonselected hospitals are not known. We set out to evaluate postoperative morbidity and mortality using a nationally representative database and to determine the factors that influenced outcomes.

Methods: We analyzed the 1995-2005 Nationwide Inpatient Sample to identify 7108 discharges for UC patients who underwent a total abdominal colectomy. The effects of hospital volume on postoperative morbidity and mortality were evaluated in logistic regression models adjusting for demographic and clinical factors.

Results: Postoperative mortality and morbidity rates were 2.3% and 30.8%, respectively. Most operations were performed in low-volume hospitals that had an increased risk of death (adjusted odds ratio [aOR], 2.42; 95% confidence interval [CI]: 1.26-4.63). In-hospital mortality was increased in patients who were admitted emergently (aOR, 5.40; 95% CI: 3.48-8.40), aged 60-80 years (aOR, 8.70; 95% CI: 3.30-22.92), and those with Medicaid (aOR, 4.29; 95% CI: 2.13-8.66). Emergently admitted UC patients whose surgery was performed 6 days after their admission had significantly increased likelihood of in-hospital death (aOR, 2.12; 95% CI: 1.13-3.97).

Conclusions: Postoperative mortality was lowest in hospitals that performed the highest volume of operations. Increasing the proportion of total colectomies performed in high-volume hospitals may improve clinical outcomes for patients with UC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Colectomy / adverse effects
  • Colectomy / mortality*
  • Colitis, Ulcerative / mortality*
  • Colitis, Ulcerative / surgery*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Male
  • Medicaid / statistics & numerical data
  • Middle Aged
  • Odds Ratio
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology