Restorative Surgery Is More Common in Ulcerative Colitis Patients With a High Income: A Population-Based StudyShow others and affiliations
2021 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 64, no 3, p. 301-312Article in journal (Refereed) Published
Abstract [en]
BACKGROUND: To avoid a permanent stoma, restorative surgery is performed after the colectomy. Previous studies have shown that less than half of patients with ulcerative colitis undergo restorative surgery. OBJECTIVE: The primary aim was to explore the association between socioeconomic status and restorative surgery after colectomy. DESIGN: This was a nationwide register-based cohort study. SETTINGS: The study was conducted in Sweden. PATIENTS: All Swedish patients with ulcerative colitis who underwent colectomy between 1990 and 2017 at the age of 15 to 69 years were included. MAIN OUTCOME MEASURES: The main outcome was restorative surgery, and the secondary outcome was failure of the reconstruction (defined as the need for a new ileostomy after the reconstruction or nonreversal of a defunctioning stoma within 2 years of the reconstruction). To calculate HRs for restorative surgery after colectomy, as well as failure after restorative surgery, multivariable Cox regression models were performed (adjusted for sex, year of colectomy, colorectal cancer diagnosis, education, civil status, country of birth, income (quartiles 1 to 4, where Q4 represents highest income), hospital volume, and stratified by age). RESULTS: In all, 5969 patients with ulcerative colitis underwent colectomy, and of those, 2794 (46.8%) underwent restorative surgery. Restorative surgery was more common in patients with a high income at the time of colectomy (quartile 1, reference; quartile 2, 1.09 (0.98-1.21); quartile 3, 1.20 (1.07-1.34); quartile 4, 1.27 (1.13-1.43)) and less common in those born in a Nordic country than in immigrants born in a non-Nordic country (0.86 (0.74-0.99)), whereas no association was seen with educational level and civil status. There was no association between socioeconomic status and the risk of failure after restorative surgery. LIMITATIONS: The study was restricted to register data. CONCLUSIONS: Restorative surgery in ulcerative colitis appears to be more common in patients with a high income and patients born in a non-Nordic country, indicating inequality in the provided care. See Video Abstract at http://links.lww.com/DCR/B433.
Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2021. Vol. 64, no 3, p. 301-312
Keywords [en]
Ileal pouch-anal anastomosis; Ileorectal anastomosis; Socioeconomic status; Ulcerative colitis
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-175721DOI: 10.1097/DCR.0000000000001775ISI: 000639299700016PubMedID: 33395139OAI: oai:DiVA.org:liu-175721DiVA, id: diva2:1555354
Conference
14th Annual Meeting of the European-Society-of-Coloproctology (ESCP), Vienna, AUSTRIA, sep 25-27, 2019
Note
Funding Agencies|Region Stockholm; Bengt Ihre research fellowship; Karolinska Institutet foundationKarolinska Institutet; Karolinska Institutets Young Scholar Award from the Strategic Research Area Epidemiology Program; Swedish Medical Society; Bengt Ihre foundation
2021-05-182021-05-182021-05-18