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Morbidity of medical therapy for ulcerative colitis: what are we really saving?
M E Sher1, E G Weiss, J J Nogueras
1Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Aim:
The true morbidity, cost and disability of medical therapy for ulcerative colitis are seldom delineated and are even less frequently compared to analogous parameters associated with surgical therapy. Therefore, we sought to assess and contrast medical versus surgical therapy for patients hospitalized due to severe ulcerative colitis.
Materials And Methods:
Patients were matched for age, duration and severity of disease based upon Truelove and Witts' activity index, colonoscopic and histologic appearance and APACHE (Acute Psychological and Chronic Health Evaluation) II scores. Morbidity, cost and disability of 20 medically treated patients who required at least one hospital admission were compared to 20 patients treated by a three stage restorative proctocolectomy. Demographic data, number of hospital admissions, length of stay, total hospital charges including consultant's, surgeon's, and anesthesiologist's fees, morbidity of each approach and disability were assessed. Statistical analysis was performed using Mann-Whitney and Fisher exact tests. Significance was considered as P < 0.05.
Results:
The mean age was 53.6 years in the medical group and 48.1 years in the surgical group (P = NS) and the average duration of disease was 10.5 years and 9.5 years, respectively (P = NS). The same severity of pancolitis was noted in both groups; APACHE scores of 13 and 14 in the medical and surgical groups, respectively, were noted. The total number of hospital admissions and total combined length of stay per patient in each group were not significant. Total mean hospital cost for the medical group was $28,477.00 per patient versus $33,041.00 for the three stage restorative proctocolectomy (P = NS). The mean duration of disability in the medical group was 6.4 months per patient versus 5.0 months in the surgical group (P = NS). However, patients in the medical group required more transfusions (25%) than did those in the surgical group (0%) (P < 0.05) and significant weight loss was more common in the medical group (45%) compared to the surgical group (5%) (P < 0.01). All patients in the surgical group were permanently weaned from steroids. Furthermore, while 65% of patients in the medical group had significant steroid-related complications, the major surgical complication rate was only 15% (P < 0.01).
Conclusion:
Medical treatment was associated with a significantly higher overall morbidity than surgical therapy. Additionally, a three stage restorative proctocolectomy was performed at no additional hospital cost or subsequent disability in patients with severe ulcerative colitis. The value of prolonged medical therapy in this select group of patients is questionable.
Insights
For severe ulcerative colitis, surgery offers better outcomes than medical therapy. A three-stage restorative proctocolectomy had similar costs and disability but lower morbidity compared to prolonged medical treatment.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Clinical Outcomes Research
Background:
- Medical therapy for ulcerative colitis (UC) has significant but often unquantified morbidity, cost, and disability.
- Comparison with surgical interventions for severe UC is infrequently reported.
- Understanding these parameters is crucial for optimal patient management.
Purpose of the Study:
- To assess and contrast the morbidity, cost, and disability of medical versus surgical therapy for hospitalized patients with severe ulcerative colitis.
- To provide a comparative analysis to inform treatment decisions for severe UC.
Main Methods:
- Matched cohort study comparing 20 medically treated patients with 20 patients undergoing three-stage restorative proctocolectomy.
- Patients matched for age, disease duration, severity (Truelove and Witts index), colonoscopic/histologic appearance, and APACHE II scores.
- Assessment of demographic data, hospital admissions, length of stay, total hospital charges, morbidity, and disability.
Main Results:
- No significant differences in mean age, disease duration, hospital admissions, or length of stay between groups.
- Mean hospital costs were comparable ($28,477 medical vs. $33,041 surgical).
- Medical therapy group experienced higher rates of transfusions (25% vs. 0%), significant weight loss (45% vs. 5%), steroid complications (65% vs. 0%), and overall morbidity (P < 0.01).
Conclusions:
- Medical treatment for severe ulcerative colitis is associated with significantly higher overall morbidity compared to surgical therapy.
- Three-stage restorative proctocolectomy offers comparable hospital costs and disability without additional long-term burden.
- The value of prolonged medical therapy in select severe UC patients is questionable, suggesting surgery as a viable alternative.