Surgery for ulcerative colitis in elderly persons - Changes in indicationsfor surgery and outcome over time

Hypothesis: Medical therapy has changed the indications for surgery over th e last 4 decades. Advances in perioperative care have significantly improve d the outcome. Design: The medical records of all patients 65 years and older Who underwen t Surgery for ulcerative colitis during a 40-year period were analyzed retr ospectively. 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 surge ry. Changes over time in outcome and the factors that brought about these c hanges. Predictors of poor outcome in an elderly population with ulcerative colitis. Results: One hundred thirteen patients were divided into 3 cohorts of 38, 3 8, 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 a n indication for urgent surgery (P=.001). Surgery-associated adverse outcom es have decreased significantly from 50% ( 13% deaths, 37% major complicati ons) to 27% (3% deaths, 24% major complications) (P=.04). Male sex, an albu min level of 2.8 g/dL or less, and urgent surgery were found to be independ ent predictors of poor outcome. Conclusions: In our referral center, the indications for urgent and electiv e surgery have changed during the past 4 decades from toxic megacolon and c arcinoma, to disease refractory, to medical therapy and dysplasia, respecti vely. Morbidity and mortality have decreased dramatically over time. Urgent procedures, low levels of albumin, and mate sex are all predictors of poor outcome.