Abstract
Background: In the era of biologic therapy, international studies have noted a trend towards declining colectomy rates in people with ulcerative colitis (UC) compared to historic data. We performed a retrospective data linkage study from a large Australian inflammatory bowel disease (IBD) database, in order to observe trends associated with colectomy in UC and provide a real-world snapshot of healthcare outcomes in the current treatment landscape.
Methods: Multi-centre data collection was performed from the Crohn’s Colitis Care registry to identify people with UC. Data on baseline demographics, disease characteristics, colectomy rates, hospitalisations, and therapy utilisation were collected. Only people with recent (within 14 months) clinical assessment were included. Univariate and multivariate regression analyses were used.
Results: Amongst 2770 people with UC (49.9% male, median age at diagnosis 29 years), 128 (4.6%) underwent colectomy between 1975 to 2025. Cumulative colectomy rates were highest during the first 5 years post-diagnosis at 4.1 per 100 person-years, then declined sharply thereafter with rates below 0.1 per 100 person-years beyond 20 years. Risk factors for colectomy included all-cause hospitalisation (OR 6.74, p<0.001), pancolitis (OR 2.78 vs left sided colitis and 2.13 vs proctitis, p<0.001) and disease duration (OR 1.36 per 5 years, p <0.001). Previous advanced therapy use was associated with a trend towards increased colectomy rates (OR 2.16, p=0.016), which may be a result of confounding from inclusion of treatment refractory cases. 5-ASA use was independently associated with lower colectomy risk (OR 0.37, p<0.001). No associations were found between colectomy risk and any of: age at diagnosis, gender, smoking, steroid use, immunomodulator use or the presence of extraintestinal manifestations (after multivariate analysis).
Conclusion: Our findings suggest that while colectomy rates are declining in UC, particularly beyond the first five years post-diagnosis, disease extent and hospitalisation remain important predictors of surgical risk despite advancements in medical therapy.