The Outcomes of Emergency Admissions with Ulcerative Colitis between 2007 and 2017 in England

BACKGROUND AND AIMS: Patients with Ulcerative Colitis (UC) may present as emergencies and require rapid escalation of therapy. This study aimed to assess the mortality, colectomy and readmission risk during and following a first emergency admission with UC. METHODS: Using Hospital Episode Statistics, subjects aged between 18-60 years, coded with a first emergency admission with UC were identified between 2007-2017. Influences of demographic factors, comorbidity, anti-TNF therapy and provider UC activity on mortality and colectomy were examined. RESULTS: 10,051 subjects (46% female; median age 33-years (IQR 25-44)) were identified. Mortality was 0.2% in-hospital and 0.5% at 12-months, and following colectomy during acute admission was 1.4% in-hospital and 2.1% at 12-months. Females had reduced risk of colectomy during admission (OR 0.73 (95%CI 0.62-0.85)). Comparing the period from 2007-2011 to 2012-2017, the rate of colectomy fell during acute admissions, OR 0.85 (0.72-0.99), p=0.038 and at 12-months after admission OR 0.73 (0.61-0.87). Anti-TNF therapy increased four-fold in acute UC admissions from 2007-2017. Those receiving anti-TNF therapy had a 70% increased risk of colectomy during index admission compared to those not receiving anti-TNF (OR 1.72 (1.29-2.31)). Increased time to colectomy during first admission was associated with female sex (HR 0.84 (0.72-0.98)) and Asian ethnicity (HR 0.61 (0.44-0.85)) while reduced time was associated with increased comorbidity, lower deprivation and high provider volume of colectomies for UC (HR 1.59 (1.31-1.93)). CONCLUSIONS: Mortality following colectomy was 1.4% in-hospital, 2.1% at 12-months, and no significant change over time was observed. Colectomy during emergency admission for UC was less common in females. Rates of anti-TNF therapy during emergency admission for UC have increased whereas overall colectomy rates have fallen.