Temporal Trends in Medical and Surgical Management of Ulcerative Colitis in England: 2003-2020

The medical management of ulcerative colitis (UC) is evolving. However, colectomy may be required in severe or refractory cases.

To provide contemporary evidence on medication usage and surgery for UC.

An incident cohort of patients newly diagnosed with UC from 2003 to 2020 was identified using computerised health records. The cumulative incidence of colectomy and medication use was calculated using Kaplan-Meier methods and compared across 3 time periods. We calculated 90-day post-operative mortality using life tables. Cox regression was used to model the risks of surgery and mortality, adjusting for confounders.

33,464 subjects had an incident diagnosis of UC. 5- year cumulative incidence of elective colectomy reduced from 2.97% to 1.59%, and emergency colectomy from 3.90% to 2.67% from 2003-2007 to 2015-2020. For elective surgery, adjusted hazard ratio (aHR) 0.47 and for emergency surgery, aHR 0.60 when 2015-2020 was compared to 2003-2007. Colectomy was less likely in women (elective aHR 0.73, emergency aHR 0.71) and emergency colectomy was less likely in those aged 40-59, aHR 0.87 than in those aged 18-39. Ninety- day mortality for elective and emergency surgery was 1.47% and 3.81%, respectively. Use of advanced therapies increased from 2.53% to 16.71% at 5 years from diagnosis when comparing 2003-2007 and 2015-2020.

Colectomy in the five years following diagnosis has declined, coinciding with an increased use of advanced therapies. Overall post-operative mortality is low. While the indication for colectomy may influence the risk of adverse outcomes, aggregate data provide a reassuring picture of current practice.