TOPLINE:

A decade-long national audit of total abdominal colectomy (TAC) for ulcerative colitis in the Republic of Ireland showed no 30-day mortality and an increased adoption of laparoscopy and identified open surgery, steroid use, and acute disease complications as key predictors of postoperative morbidity.

METHODOLOGY:

• Researchers conducted a retrospective audit of medical records from 13 hospitals in the Republic of Ireland to determine outcomes and trends for emergency and elective TAC in patients with ulcerative colitis and to identify factors predicting postoperative complications.
• They analysed data of 469 adult patients (median age, 40 years; 64.4% men) who underwent TAC for ulcerative colitis between January 2013 and December 2022, with a median follow-up duration of 35 months.
• Primary outcomes were 30-day postoperative morbidity and mortality, and secondary outcomes included reoperation and readmission rates and preoperative and postoperative length of stay.
• The timing of surgery was recorded as elective if the decision to operate was made before hospitalisation as a planned admission or as emergency if the decision was made during an unplanned admission for acute severe ulcerative colitis.

TAKEAWAY:

• The postoperative morbidity rate at 30 days was 43.0%, with severe morbidity seen in 11.7% of patients, and no 30-day mortality was observed.
• Readmission occurred in 7.5% of cases, primarily due to surgical site infection (n = 14), small bowel obstruction (n = 3), venous thromboembolism (n = 3), and high-output ileostomy (n = 2), and reoperation was required in 5.5% of cases.
• A minimally invasive surgical approach was utilised in 71.8% of cases, with a median postoperative length of stay being significantly longer for open vs laparoscopic surgery (15 vs 8 days; P < .001). An increase in the use of laparoscopy was observed from 2013-2017 to 2018-2022 (P = .002).
• Open surgery (odds ratio [OR], 2.46; P < .001) and acute disease complications (OR, 2.44; P = .013) were predictors of 30-day postoperative morbidity; however, biologic use was found to be protective against morbidity (OR, 0.57; P = .018).

IN PRACTICE:

"The slower progression to subsequent surgery is likely multifacto­rial, with patient, societal, clinician, and healthcare systems factors all contributing," the authors of the study wrote.

SOURCE:

This study was led by Ian J.B. Stephens, MB BCh BAO, Beaumont Hospital, Dublin, Republic of Ireland. It was published online on December 28, 2025, in Inflammatory Bowel Diseases.

LIMITATIONS:

Certain perioperative datapoints could not be collected.

DISCLOSURES:

Stephens received support from a Royal College of Surgeons Ireland/Bon Secours Hospital Dublin Strategic Academic Recruitment Medical Doctorate fellowship. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.