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Changes in Indications for Surgery and Outcome Over Time

Gidon Almogy, MD; David B. Sachar, MD; Carol A. Bodian, DrPH; Adrian J. Greenstein, MD

Arch Surg. 2001;136:1396-1400.

Hypothesis  Medical therapy has changed the indications for surgery over the last 4 decades. Advances in perioperative care have significantly improved the outcome.

Design  The medical records of all patients 65 years and older who underwent surgery for ulcerative colitis during a 40-year period were analyzed retrospectively.

Setting  Tertiary referral center.

Patients  One hundred thirteen consecutive patients 65 years and older who underwent surgery for ulcerative colitis between January 1, 1960, and June 30, 1999.

Main Outcome Measures  Changes in elective and urgent indications for surgery. Changes over time in outcome and the factors that brought about these changes. Predictors of poor outcome in an elderly population with ulcerative colitis.

Results  One hundred thirteen patients were divided into 3 cohorts of 38, 38, and 37 consecutive patients admitted to the hospital during the periods 1960 through 1984, 1985 through 1993, and 1994 through 1999, respectively. Indications for surgery and morbidity and mortality rates have changed with time. Dysplasia has replaced carcinoma as a major indication for elective surgery (P = .001). Toxic megacolon has become significantly less common as an indication for urgent surgery (P = .001). Surgery-associated adverse outcomes have decreased significantly from 50% (13% deaths, 37% major complications) to 27% (3% deaths, 24% major complications) (P = .04). Male sex, an albumin level of 2.8 g/dL or less, and urgent surgery were found to be independent predictors of poor outcome.

Conclusions  In our referral center, the indications for urgent and elective surgery have changed during the past 4 decades from toxic megacolon and carcinoma, to disease refractory, to medical therapy and dysplasia, respectively. Morbidity and mortality have decreased dramatically over time. Urgent procedures, low levels of albumin, and male sex are all predictors of poor outcome.

From the Departments of Surgery (Drs Almogy and Greenstein), Medicine (Division of Gastroenterology) (Dr Sachar), and Biomathematical Sciences (Dr Bodian), Mount Sinai Hospital and the Mount Sinai School of Medicine, New York, NY. Dr Almogy is now with the Department of Surgery, Hadassah University Hospital, Jerusalem, Israel.

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