In this week's BMJ, Roberts and colleagues used record linkage analysis to compare mortality rates after elective colectomy, emergency colectomy, and no colectomy in people admitted with inflammatory bowel disease.1 The results are important and indicate that thresholds for undertaking elective colectomy in clinical practice are too high.

The chronic inflammatory bowel diseases—ulcerative colitis and Crohn's disease—affect 1.4 million people in the United States and 2.2 million people in Europe.2 They result in substantial morbidity, lost days at work, and reduced quality of life. Despite a variety of advances in medical treatment, 20-30% of patients with ulcerative colitis need surgery at some time,3 while the lifetime risk of surgery for Crohn's disease is as high as 80%.4 In people with severe inflammatory bowel disease the long term effectiveness of drugs, such as immunomodulators, rarely exceeds 40%. Surgery can be regarded as a cure for ulcerative colitis, albeit an imperfect one. Similarly, surgery can be highly effective in Crohn's disease but is offset by the recurring nature of the disease.

The …