Impact of restorative proctocolectomy for ulcerative colitis on service retention in the US military

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that affects military service members with potential for involuntary medical separation. This study investigates functional return to duty after restorative proctocolectomy in active-duty service members.

This retrospective study utilized data from the Medical Assessment and Readiness System at Womack Army Medical Center to identify subjects with initial diagnosis of UC between 2012 and 2017 who underwent restorative proctocolectomy using diagnosis and procedure codes. Medical and non-medical discharges acted as main outcome measures and were extracted using personnel records. Subjects were followed up for up to four and one-half years after diagnosis. Variables including history of surgery, tobacco use, BMI, age over 40, military occupational specialty (MOS), rank, and branch of service were analyzed using Chi-square, two-sided t-tests, and multivariable regression model. A 95% confidence interval was applied to the analyses.

Among 3809 UC patients, restorative proctocolectomy was performed in 1.5%. Among those undergoing operative intervention, 51% were able to avoid medical discharge. Restorative proctocolectomy was associated with a higher risk of medical discharge (aHR: 2.11; 95% CI: 1.45 to 3.09; P < 0.001) compared to non-surgical UC patients. Service branch, tobacco use, BMI, age, and pay grade demonstrated statistical significance regarding medical discharge risk. All retained subjects returned to prior MOS.

Restorative proctocolectomy provides a viable path for service continuation in military personnel with severe or refractory ulcerative colitis. These personnel would typically require biologic medications which would necessitate involuntary separation. In this study, restorative proctocolectomy allowed more than half of the study population to successfully reintegrate into roles requiring significant physical demand and psychologic resilience. Although operative intervention was associated with an increased risk of medical discharge compared to all service members diagnosed with ulcerative colitis, this association is likely confounded by underlying disease severity rather than operative intervention itself.