Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications

Br J Surg. 2010 Mar;97(3):404-9. doi: 10.1002/bjs.6874.


Background: This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome.

Methods: All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded.

Results: Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1-22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch-anal anastomosis in 57. During a median follow-up of 5.4 (range 0.5-9.0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0.036).

Conclusion: Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / surgery*
  • Cyclosporine / administration & dosage
  • Elective Surgical Procedures
  • Female
  • Humans
  • Infusions, Intravenous
  • Length of Stay
  • Male
  • Middle Aged
  • Postoperative Complications / etiology*
  • Preoperative Care
  • Risk Factors
  • Steroids / administration & dosage
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Steroids
  • Cyclosporine