The Utility of the Colectomy Risk Score in Terms of Predicting Postoperative Complications in Patients with Ulcerative C
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RESEARCH COMMUNICATION
The Utility of the Colectomy Risk Score in Terms of Predicting Postoperative Complications in Patients with Ulcerative Colitis Akiyoshi Ikebata 1 & Koji Okabayashi 1 & Masashi Tsuruta 1 & Kohei Shigeta 1 & Ryo Seishima 1 & Makoto Naganuma 2 & Yuko Kitagawa 1 Received: 27 March 2020 / Accepted: 19 July 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Ulcerative colitis . Restorative proctocolectomy . Complications . Risk score
Introduction Risk stratification specific for ulcerative colitis (UC) is required to improve postoperative outcomes of patients undergoing restorative proctocolectomy (RPC). Ananthakrishnan et al. 1 confirmed the utility of the colectomy risk score (CRS) in assessing UC severity and predicting the necessity for surgery. However, the usefulness of CRS for other aspects of UC is unclear. This study examined whether CRS could predict the incidence of complications in patients with UC.
included in multivariate logistic regression analyses. The study was approved by our university’s ethics committee (20150051).
Results
This retrospective study included 140 UC patients who underwent two-stage or three-stage RPC to treat UC between April 2002 and December 2017. Based on their CRS, patients were assigned to low- (score 0–3), intermediate- (4–6), and high-risk groups (7–9). The CRS, modified Glasgow prognostic score (mGPS), and Lichtiger index 2 were calculated using data recorded immediately before surgery. The main outcome was risk of postoperative complications, as indexed by CRS, other clinical factors, and the Clavien–Dindo (CD) classification. CRS validity was explored by logistic regression analysis. All variables with P < 0.10 on univariable logistic regression analyses were
Postoperative complications occurred in 10 of 31 (32.3%; 95% confidence interval [CI] 16.7–51.4%) patients in the low-risk group, 21 of 53 (39.6%; 95% CI 26.5–54.0%) patients in the intermediate-risk group, and 36 of 56 (64.3%; 95% CI 50.4–76.6%) patients in the high-risk group (Fig. 1a). The incidence of complications was significantly greater in the high-risk group than the low-risk group (P < 0.01). mGPS and Lichtiger index were not significantly associated with the extent of complications (Fig. 1b,c). The incidence of CD grades III–IV complications was significantly greater in the high-risk group (low-risk, 4 of 38, 10.5%, 95% CI: 2.9–24.8%; intermediate-risk, 11 of 38, 28.9%, 95% CI: 15.4–45.9%; high-risk, 23 of 38, 60.5%, 95% CI: 43.4.3–76.0%, P < 0.01, Fig. 1d). Thus, the highrisk group had an elevated risk of postoperative grades III– IV complications. Multivariate analysis showed that high-risk status was an independent predictor of postoperative complications (odds ratio: 3.63; 95% CI: 1.38–9.51; P < 0.01; Table 1).
* Koji Okabayashi [email protected]
Discussion
Methods
1
Department of Surgery, Keio University School of Medicine, Tokyo, Japan
2
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medi
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