Twelve percent of patients in a large US real-world cohort hospitalized with severe ulcerative colitis underwent colectomy during index admission. The cumulative risk of colectomy within 1 year of index hospitalization was about 20%, according to a retrospective cohort study in the Journal of Crohn’s and Colitis.
Study design and patient characteristics
In the study, researchers analyzed electronic health record data linked to insurance claims from January 1, 2014, to December 31, 2022, to evaluate outcomes among adult patients hospitalized with ulcerative colitis who received intravenous corticosteroids during admission, consistent with standard-of-care definitions used to identify severe disease in retrospective analyses. The cohort included 9,716 patients (mean age, 46 years; 53% female), of whom 83% had a prior diagnosis of ulcerative colitis and 24% had prior biologic use for ulcerative colitis.
In-hospital treatment and colectomy rates
During hospitalization, 13% of patients received advanced therapy, primarily biologics, and 12% underwent colectomy. Colectomy rates varied by prior disease and treatment history: 13% among patients without a prior diagnosis, 9% among those with prior diagnosis but no advanced therapy, and 20% among those with prior advanced therapy exposure. Multivariable analysis identified prior advanced therapy use and abnormal or missing albumin values as factors associated with higher risk of colectomy.
Short-term outcomes showed that 14% of patients experienced ulcerative colitis–related readmission within 30 days of discharge. Median length of stay was 5 days, with longer stays observed among patients without prior diagnosis.
Post-discharge outcomes and treatment use
Among patients discharged without colectomy who had sufficient follow-up for the nested analysis (n = 4,383), post-discharge burden remained high. Within 1 year, 8% of these patients underwent colectomy, with a median time to surgery of about 3 months, and 38% had a disease-related hospitalization. Advanced therapy use increased following discharge but remained limited, with 33% receiving advanced therapy within 90 days and 44% within 1 year.
“I was surprised by the large proportion of patients for whom treatment after hospital discharge did not include a modern targeted therapy,” said James D. Lewis, MD, MSCE, Professor of Medicine and Epidemiology, Division of Gastroenterology and Hepatology at the University of Pennsylvania’s Perelman School of Medicine, in an interview with GI & Hepatology News. “Given the high rates of colectomy within one year, this appears to be an important target for quality improvement in the care of patients with ulcerative colitis.”
Subgroup analyses demonstrated worse outcomes among patients with prior advanced therapy exposure, who had the highest rates of colectomy both during hospitalization (20%) and within 1 year (33% cumulative risk of colectomy from index hospitalization) and the highest rate of subsequent hospitalization (43%).
Study strengths and limitations
The study used a large, geographically diverse data set combining electronic health records with claims data, allowing assessment of treatment patterns and outcomes across real-world practice. Sensitivity analyses restricting to more recent years, longer baseline observation, and linked claims data yielded consistent results.
Limitations of the study include potential coding errors, incomplete capture of treatments and laboratory data, and underestimation of advanced therapy use or colectomy events performed outside captured systems. In addition, missing laboratory values, particularly albumin, may have introduced bias but were also associated with higher colectomy risk. The observational design does not establish causality, noted investigators.
“It was not surprising that the colectomy rate was the highest among those who had already been treated with an advanced therapy,” said Dr. Lewis. “These patients may have been running out of treatment options. However, this also highlights the need to identify optimal second- and third-line treatment options for patients with severe ulcerative colitis.”
The study was funded by AbbVie. Multiple researchers reported consulting fees, research support, or employment with AbbVie and other pharmaceutical companies; several researchers are AbbVie employees and may hold stock.