Proctocolectomy linked to elevated readmission rates in paediatric UC

Children with ulcerative colitis (UC) who undergo a proctocolectomy may have an increased risk of readmission to hospital 30 days after their initial hospital admission, according to a retrospective cohort study presented at the recent Crohn’s and Colitis Congress 2020.

Using the National Surgical Quality Improvement Program–Pediatrics (NSQIP-P), the researchers identified 489 children (median age 14.9 years, 48 percent female, 79 percent Caucasian) with UC who underwent total abdominal colectomy (TAC) between 2012 and 2017. Of these, 29 percent underwent proctocolectomy. Sixty-eight percent of the surgeries were done laparoscopically. Ninety percent were elective surgeries.

Overall, 19.4 percent of patients were readmitted to hospital within 30 days of index hospitalization.

After adjusting for multiple factors including patient demographics, operative time, type of procedure (open vs laparoscopic), and initial duration of hospitalization, the risk of readmission to hospital within 30 days was increased by twofold among those who underwent proctocolectomy compared with those who underwent colectomy only (odds ratio, 2.4, 95 percent confidence interval, 1.1–5.2). [Crohn’s and Colitis Congress 2020, Opening Breakout Session, presentation number 4]

Patient demographics such as age, sex, and race were not associated with an elevated risk of readmission at 30 days, nor was type of procedure (open vs laparoscopic) or pre-operative laboratory values (platelet count, haematocrit or albumin levels).

A previous single-centre study comprising 209 adult patients with UC who underwent a colectomy showed that 32 percent of them were unexpectedly readmitted to hospital within 30 days, with proctocolectomy with ileoanal pouch anastomosis (IPAA) and diverting ileostomy associated with elevated re-hospitalization risk. [Inflamm Bowel Dis 2015;21:2130-2136]

Children with UC often require TAC and have an elevated risk of readmission to hospital, said study author Assistant Professor Matthew Egberg from the University of North Carolina, Chapel Hill, North Carolina, US. However, efforts to improve post-surgery outcomes in this population fall short due to lack of data on 30-day hospital readmission.

“[This study showed that] nearly one-fifth of annual paediatric UC hospitalizations involving a colectomy result in a hospital readmission within 30 days [with] proctocolectomies increase[ing] the risk of 30-day hospital readmission compared with TAC alone,” he said.

“These results can inform risk management strategies aimed at reducing morbidity and hospital readmissions for children with UC,” said Egberg. Quality improvement efforts can help minimize hospital readmissions. These include close monitoring of patients following discharge from hospital and using Enhanced Recovery After Surgery (ERAS) protocols, he said.

In addition, longitudinal studies are warranted to assess the safety and long-term benefits of staged procedures, he noted.