Abstract：
OBJECTIVE: Total (procto)colectomy for ulcerative colitis (UC) is associated with significant morbidity, which is increased in the emergency setting. This study aimed to evaluate the outcomes following total (procto)colectomies at a population level within New South Wales (NSW), Australia, and identify case mix and hospital factors associated with these outcomes.
METHODS: A retrospective data linkage study of patients undergoing total (procto)colectomy for UC in NSW over a 19-year period (2001-2020) was performed. The primary outcome was 90-day mortality. The influence of hospital level factors (including annual volume) and patient demographic variables on outcomes was assessed using logistic regression. Temporal trends in annual volume and evidence for centralization were assessed.
RESULTS: In all, 1418 patients (mean 47.0 years [SD 18.7], 58.7% male) underwent total (procto)colectomy during the study period. The overall 90-day mortality rate was 3.2% (emergency 8.6% and elective 0.8%). After adjusting for confounding, increasing age at total (procto)colectomy, higher comorbidity burden, public health insurance (Medicare) status, emergency operation and living outside a major city were significantly associated with increased mortality. Hospital volume was significantly associated with mortality at a univariate level, but this did not persist on multivariate modelling.
CONCLUSIONS: Outcomes of UC patients undergoing total (procto)colectomy in NSW Australia are comparable to international experience. Whilst higher mortality rates are observed in low volume and public hospitals, this appears attributable to case mix and acuity rather than surgical volume alone. However, as inflammatory bowel disease surgery is not centralized in Australia, only one NSW hospital performed >10 UC total (procto)colectomies annually. Variation in mortality according to insurance status and across regional/remote areas may indicate inequality in the availability of specialist inflammatory bowel disease treatment, which warrants further research.
METHODS: A retrospective data linkage study of patients undergoing total (procto)colectomy for UC in NSW over a 19-year period (2001-2020) was performed. The primary outcome was 90-day mortality. The influence of hospital level factors (including annual volume) and patient demographic variables on outcomes was assessed using logistic regression. Temporal trends in annual volume and evidence for centralization were assessed.
RESULTS: In all, 1418 patients (mean 47.0 years [SD 18.7], 58.7% male) underwent total (procto)colectomy during the study period. The overall 90-day mortality rate was 3.2% (emergency 8.6% and elective 0.8%). After adjusting for confounding, increasing age at total (procto)colectomy, higher comorbidity burden, public health insurance (Medicare) status, emergency operation and living outside a major city were significantly associated with increased mortality. Hospital volume was significantly associated with mortality at a univariate level, but this did not persist on multivariate modelling.
CONCLUSIONS: Outcomes of UC patients undergoing total (procto)colectomy in NSW Australia are comparable to international experience. Whilst higher mortality rates are observed in low volume and public hospitals, this appears attributable to case mix and acuity rather than surgical volume alone. However, as inflammatory bowel disease surgery is not centralized in Australia, only one NSW hospital performed >10 UC total (procto)colectomies annually. Variation in mortality according to insurance status and across regional/remote areas may indicate inequality in the availability of specialist inflammatory bowel disease treatment, which warrants further research.
摘要：
目的：溃疡性结肠炎（UC）的全（直肠）结肠切除术与显着的发病率相关，在紧急情况下增加。这项研究旨在评估新南威尔士州（NSW）人口水平的总（前）结肠切除术后的结果，澳大利亚,并确定与这些结果相关的病例组合和医院因素。
方法：对19年（2001-2020年）在新南威尔士州接受UC全（直肠）结肠切除术的患者进行了回顾性数据链接研究。主要结果是90天死亡率。使用逻辑回归评估医院级别因素（包括年度容量）和患者人口统计学变量对结果的影响。评估了年度数量的时间趋势和集中化的证据。
结果：总而言之，1418例患者（平均47.0年[SD18.7]，58.7％的男性）在研究期间接受了总（直肠）结肠切除术。总体90天死亡率为3.2%(急诊8.6%和选择性0.8%)。在调整混杂因素后，总（直肠）结肠切除术的年龄增加，较高的共病负担，公共医疗保险(Medicare)状态，紧急手术和生活在大城市以外与死亡率增加显著相关.在单变量水平上，医院容量与死亡率显着相关，但这在多变量建模中并不存在。
结论：在澳大利亚新南威尔士州接受全（前）结肠切除术的UC患者的结果与国际经验相当。虽然在低容量和公立医院中观察到较高的死亡率，这似乎归因于病例混合和敏锐度，而不仅仅是手术量。然而,由于炎症性肠病手术在澳大利亚并不集中，新南威尔士州只有一家医院每年进行>10次UC总（前）结肠切除术。根据保险状况和不同地区/偏远地区的死亡率变化可能表明，在获得专门的炎症性肠病治疗方面存在不平等。这值得进一步研究。
方法：对19年（2001-2020年）在新南威尔士州接受UC全（直肠）结肠切除术的患者进行了回顾性数据链接研究。主要结果是90天死亡率。使用逻辑回归评估医院级别因素（包括年度容量）和患者人口统计学变量对结果的影响。评估了年度数量的时间趋势和集中化的证据。
结果：总而言之，1418例患者（平均47.0年[SD18.7]，58.7％的男性）在研究期间接受了总（直肠）结肠切除术。总体90天死亡率为3.2%(急诊8.6%和选择性0.8%)。在调整混杂因素后，总（直肠）结肠切除术的年龄增加，较高的共病负担，公共医疗保险(Medicare)状态，紧急手术和生活在大城市以外与死亡率增加显著相关.在单变量水平上，医院容量与死亡率显着相关，但这在多变量建模中并不存在。
结论：在澳大利亚新南威尔士州接受全（前）结肠切除术的UC患者的结果与国际经验相当。虽然在低容量和公立医院中观察到较高的死亡率，这似乎归因于病例混合和敏锐度，而不仅仅是手术量。然而,由于炎症性肠病手术在澳大利亚并不集中，新南威尔士州只有一家医院每年进行>10次UC总（前）结肠切除术。根据保险状况和不同地区/偏远地区的死亡率变化可能表明，在获得专门的炎症性肠病治疗方面存在不平等。这值得进一步研究。
