Probability, rate and timing of reconstructive surgery following colectomy for inflammatory bowel disease in Sweden: a population‐based cohort study

C Nordenvall, P Myrelid, A Ekbom, M Bottai, K E Smedby, O Olén, P J Nilsson

Many patients with inflammatory bowel disease (IBD) need colectomy, but the rate of surgery with restoration of intestinal continuity is unknown. The aim of this study was to investigate the probability, rate and timing of reconstructive surgery after colectomy in patients with IBD in a population-based setting. The study cohort included all IBD patients in Sweden who underwent colectomy from 2000 to 2009. Each patient was followed from admission for colectomy to admission for reconstructive surgery, date of death, migration or December 31(st) 2010. Kaplan-Meier survival curves and multivariable Poisson regression models were used to describe the probability, rate and timing of reconstructive surgery. Out of 2818 IBD patients treated with colectomy, 61.0% were male and 78.9% had ulcerative colitis. No reconstructive surgery had been performed in 1595 (56.6%) patients at end of follow up. In the remaining 1223 patients, 526 underwent primary reconstructive surgery and 697 had a secondary reconstruction following a median interval of 357 days from primary surgery in the form of colectomy. The probability of reconstructive surgery was dependent on age (55.6% and 18.1% at ages 15-29 and ≥59 years), and the chance of reconstructive surgery was higher in hospitals yearly performing more than 13 colectomies for inflammatory bowel disease per year (incidence rate ratio and 95% confidence interval: 1.27 (1.09-1.49)). Less than half of the patients having a colectomy for inflammatory bowel disease underwent subsequent reconstructive surgery. High age and low hospital volume were risk factors for no reconstructive surgery. This article is protected by copyright. All rights reserved.