Risk factors for complications after total colectomy in ulcerative colitis.

Ulcerative colitis is a chronic idiopathic colitis which could be cured by total proctocolectomy. However, postoperative morbidity rate is signi ficant. The aim of this study was to investigate the risk factors for colectomy-related complication in ulcerative colitis. All patients who underwent ulcerative colitis related total colectomy at Seoul National University Hospital from January 1990 to December 2009 were prospectively enrolled were then analyzed retrospectively. They were followed up for complication development. Median follow up duration was 6.2 years. Their demographic, clinical characteristics were reviewed by medical records. A total of 85 patients (35 male, 50 female) were enrolled and were analyzed. Most of them (N=78, 92%) received ileal pouch-anal anastomosis. A total of 39 (45.9%) patients had re-admitted unexpectedly due to complications (95 hospitalizations) and 23 (27.1%) underwent further surgical procedures due to complications (44 surgical procedures). Most common causes of rehospitalization and reoperation were development of pouchitis and pouch-vaginal fistula. Multivariate analysis showed that female gender (OR, 3.06; 95% CI 1.03-9.13; P=0.04), urgent surgery after medical treatment failure (OR, 3.30; 95% CI 0.03-10.50; P=0.04) and postoperative pathologic diagnosis of dysplasia/cancer (OR, 4.16; 95% CI 1.13-15.34; P=0.03) were the independent risk factors for complication-related rehospitalization. Complication-related reoperation was associated with pouchitis (OR, 6.33; 95% CI 1.40-27.40; P=0.01) and frequent previous UC flare up (OR, 1.40; 95% CI 1.05-1.86; P=0.002).