P1102 Albumin predicts post-operative complications in Acute Severe Ulcerative Colitis

Background

Acute severe ulcerative colitis (ASUC), defined by the modified Truelove and Witts criteria, is a potentially life-threatening condition. Randall et al showed over a decade ago that prolonged medical therapy prior to surgery was associated with a higher rate of major post-operative complications.(1) We undertook a retrospective cohort study with the aim of identifying other clinical parameters that could predict adverse outcomes following colectomy in the setting of ASUC.

Methods

We identified patients who had undergone colectomy for ASUC across 5 UK hospitals forming part of a trainee research network (the South West and Peninsula Research in Gastroenterology (SPRinG) network) over a 10-year period. We undertook a notes review for all these patients and compared pre-operative biomarkers (CRP, albumin) as well as length of stay prior to surgery in those who had a post-operative complication with those who did not.

Results

We identified 126 patients who had undergone colectomy for ASUC. 57% were male and 43% female. Median age was 44. 47% patients (n=59) received rescue therapy (ciclosporin n=17, infliximab n=40, Ustekinumab n=1, unclear from documentation n=1), 37% did not receive rescue therapy (n=46) and documentation was not found in 16% (n=21). Pre-operative albumin level was significantly lower in those who developed a post-operative complication up to 30 days (p=0.04, 95% CI 0.13, 4.68) (Figure1). It was not possible to identify a specific albumin level below which the risk of post-operative complications increases. There was no difference in length of stay prior to surgery, number of days of intravenous corticosteroid treatment, or pre-operative CRP between those who developed post-operative complications up to 30 days and those who did not. Of those who had complications within 30 days (66/126), the most common complications were abscess or wound infection (n=14) and ileus (n=12). Death occurred in 2 patients within 30 days.

Conclusion

We have shown that pre-operative albumin is associated with post-operative complications in ASUC. Our findings do not support the previous observation that prolonged medical therapy (either measured by length of stay or by number of days of intravenous corticosteroid treatment) prior to surgery increases the risk of post-operative complications.

References

1.Randall J, Singh B, Warren BF, Travis SP, Mortensen NJ, George BD. Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications. Br J Surg. 2010;97(3):404-9.

Table 1 Comparison of clinical parameters between patients with and without complications up to 30 days

Figure 1 Pre-operative albumin in those with and without complications up to 30 days