- Stephen E Roberts, senior lecturer in epidemiology1,
- John G Williams, professor of health services research1,
- David Yeates, computer scientist2,
- Michael J Goldacre, professor of public health2
- 1School of Medicine, Swansea University, Swansea SA2 8PP
- 2Department of Public Health, University of Oxford
- Correspondence to: S E Roberts
- Accepted 23 August 2007
Objective To compare mortality outcomes in the three years after elective colectomy, no colectomy, and emergency colectomy among people admitted to hospital for inflammatory bowel disease, to inform whether the threshold for elective colectomy in clinical practice is appropriate.
Design Record linkage studies.
Setting Oxford region (1968-99) and England (1998-2003).
Participants 23 464 people with hospital stay for more than three days for inflammatory bowel disease, including 5480 who had colectomy.
Main outcome measures Case fatality, relative survival, and standardised mortality ratios.
Results In the Oxford region, three year mortality was lower after elective colectomy than after either no colectomy or emergency colectomy, although this was not significant. For England, mortality three years after elective colectomy for ulcerative colitis (3.7%) and Crohn's disease (3.3%) was significantly lower than that after either admission without colectomy (13.6% and 10.1%; both P<0.001) or emergency colectomy (13.2% and 9.9%; P<0.001 for colitis and P<0.01 for Crohn's disease). Three or more months after elective colectomy, mortality was similar to that in the general population. Adjustment for comorbidity did not affect the findings.
Conclusions In England, the clinical threshold for elective colectomy in people with inflammatory bowel disease may be too high. Further research is now required to establish the threshold criteria and optimal timing of elective surgery for people with poorly controlled inflammatory bowel disease.
We thank Leicester Gill and Glenys Bettley for building the linked datasets and Alan Watkins for help with providing confidence intervals for relative survival.
Contributors: SER, JGW, and MJG designed the study, interpreted the findings, and wrote the manuscript. SER reviewed the literature. DY and SER undertook the analyses. SER, JGW, and MJG are guarantors.
Funding: This study was supported partly by the NHS Information Centre's funding of the hospital episode statistics for physicians' project and partly by the NHS National Centre for Research Capacity Development.
Competing interests: None declared.
Ethical approval: Central and South Bristol multicentre research ethics committee (04/Q2006/176).
- Accepted 23 August 2007