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Background
Although colectomy has long been considered definitive treatment for fulminant ulcerative colitis (UC) unresponsive to medical management, debate persists as to the proper timing of surgery. Early surgical intervention may be beneficial to patients with acute UC. Our goal was to compare outcomes of those undergoing colectomy for acute UC and to identify pre-operative factors that might predict poor outcome.
Methods
The charts of 107 patients treated by subtotal colectomy with ileostomy for severe fulminant ulcerative colitis from January 2004 to June 2009 were retrospectively reviewed. Twenty-nine patients sustained a major post-operative complication while 78 patients recovered uneventfully. Post-operative length of stay, OR time, estimated blood loss, 30-day readmission/reoperation rates as well as peri-operative morbidity and mortality were compared using student t-test, Fisher exact and chi-square analysis when appropriate.
Results
Admission WBC was significantly higher among patients who developed a post-operative complication, but there were no other differences in patient characteristics (age, gender, ASA class, chronic steroid use), other measures of acute illness (hemoglobin, albumin) or extent of disease involvement (left-sided versus extensive). Univariate analysis showed that patients who developed post-operative complications were taken to surgery significantly later (3.6 vs. 6.6 days, p = 0.01) than those who recovered uneventfully. While laparoscopic colectomy took significantly longer (168 vs. 223 minutes, p < 0.01) than open surgery, it did not convey an elevated risk of morbidity. No other parameter studied, including administration of several specific medical therapies (antibiotics, intravenous steroids, immunosuppressive agents or anti-inflammatory drugs), was significant for predicting postoperative complications. Similar percentages of patients in both groups eventually underwent ileal pouch anal anastomosis (68% vs. 77%, p = 0.5).
Conclusions
Prolonged duration of pre-operative medical treatment correlates with poor post-operative outcomes following colectomy for acute, fulminant UC. Additionally, sustaining a major post-operative complication does not prevent patients from eventually undergoing ileal pouch anal anastomosis.
Post-Operative Complications (within 30 days)

COMPLICATION	N (%)
Wound infection	6 (6)
Intra-Abdominal Abscess Percutaneous drainage Operative drainage	9 (8) 7 (7) 1 (1)
Small bowel obstruction Transient Reoperation	10 (9) 7 (7) 3 (3)
Duodenal ulcer	2 (2)
Clostridim difficile infection	3 (3)
Dehiscence	4 (4)
Pneumonia	2 (2)
Sepsis	2 (2)