CRUCIAL Insights From a Decade Long Retrospective National Audit of Total Abdominal Colectomy Outcomes for Ulcerative...

Total abdominal colectomy (TAC) is a key surgical intervention for patients with ulcerative colitis (UC), particularly in the setting of acute severe disease or medically refractory colitis. While international studies have reported outcomes using registry data, these are often limited by diagnostic coding variability and inclusion of a heterogeneous surgical procedure mix.

A retrospective national audit of perioperative outcomes following TAC for UC in Ireland over a 10-year period (2013-2022) was performed. Data were collected at 13 hospitals, from review of clinical records, and validated by trained clinicians. Primary outcomes were 30-day postoperative morbidity and mortality. Secondary outcomes included reoperation, readmission, use of laparoscopy, and length of stay (LoS).

A total of 469 patients with a preoperative diagnosis of UC underwent TAC. Median age was 40 years; 64.4% were male. Emergency surgery accounted for 67.3% of cases, with high rates of preoperative medical therapy (steroids 82.6%, biologics 69.3%). Laparoscopy was used in 71.8% of operations. Postoperative morbidity rate was 43.0%, severe morbidity was 11.7%, and 30-day mortality was 0%. Multivariable analysis identified open surgery, steroid use, and acute disease complications as predictors of morbidity and biologic use as protective.

This national audit demonstrates low mortality and acceptable morbidity following TAC for UC, with increasing use of laparoscopy over time. The robust, diagnosis-validated data support international standards of care and highlights key predictors of postoperative complications in this population. It identifies elderly, immunosuppressed patients requiring emergency open surgery as the highest risk patient subgroup.