Colectomy rates in ulcerative colitis: A systematic review and meta-analysis

Background: Surgical management in Ulcerative Colitis (UC) is typically utilised in medically refractory cases and, therefore, it is a useful marker for efficacy of medical management.Aims: To understand the changing prevalence of colectomy in UC over time.Methods: A systematic review was conducted using MEDLINE (1946-2021), EMBASE and EMBASE classic (1947-2021) to identify studies with a population of n > 500 that reported colectomy rates in UC patients > 18 years old. The primary outcome was the prevalence of colectomy at 1-, 5- and 10-years postdiagnosis. Secondary outcomes included colectomy rates in the pre-biologics (defined as pre-2004) and post-biologics eras (defined as post-2004).Results: Thirty-one studies with 294,359 patients with UC were included for review and meta-analysis. The prevalence of colectomy at 1-, 5- and 10-years post-diagnosis were 3% (95% CI 2%-6%), 5% (95% CI 2%-9%), 10% (95% CI 6%-16%) respectively. The pooled relative risk for colectomy in the post-biologics era was 0.68 (95% CI 0.42 to 1.09, p = 0.10) at 1-year and 0.71 (95% CI 0.56 to 0.91, p < 0.01) at 5-years post-diagnosis.Conclusion: The overall colectomy rate has decreased over the past three decades. Biologics may have played a role in reducing the risk of colectomy, however the relative risk reduction is likely to be modest.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.