OP35Elective colectomy vs continuing medical therapy in Ulcerative Colitis: Evidence of a survival benefit from a nationwide study

Abstract Background As medical options for ulcerative colitis (UC) continue to expand, colectomy is increasingly deferred in favor of additional trials of medical therapy. However, such deferral must be balanced against the risks of ongoing inflammation, including the development of frailty and malnutrition, as well as the potential need for emergency surgery, all of which may increase mortality. Therefore, in this nationwide matched cohort study of individuals with UC, we evaluated whether elective colectomy is associated with reduced all-cause mortality as compared with continuing medical therapy. Methods Using nationwide Danish registries, we identified all individuals aged ≥18 years with ulcerative colitis (UC) between 1996 and 2021. Those who underwent elective colectomy were propensity score–matched (1:3) to individuals who continued medical therapy to balance disease activity and baseline demographics. The Kaplan–Meier estimator was used to compare the cumulative incidence of all-cause mortality between the two cohorts, and Cox proportional hazard models were used to evaluate effect modification, yielding adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results A total of 2,300 individuals with UC who underwent elective colectomy were matched to 6,900 individuals who continued medical therapy, comprising a total study population of 9,200. Overall, 50% were female, the median age was 43 years (IQR 30–60), the median disease duration was 2 years, and 27.8% had received anti-TNF therapy in the year prior. The cumulative incidence of death at 10 years was 13% in the elective colectomy cohort and 17% in the medical therapy cohort, and at 20 years was 24% and 31%, respectively (p-value0.01; Figure 1). When assessing for effect modification, individuals who required systemic corticosteroids in the year prior had a significantly lower hazard of mortality compared with those who continued medical therapy (aHR 0.81, 95% CI 0.71–0.93; Figure 2). Although not statistically significant, similar trends were observed among older adults (≥60 years; aHR 0.88, 95% CI 0.77–1.01) and those hospitalized for ≥7 days for an IBD-related indication in the year prior (aHR 0.84, 95% CI 0.73–0.98). Conclusion In this nationwide cohort, elective colectomy was associated with a significant mortality benefit compared with continuing medical therapy, particularly among patients who required systemic corticosteroids in the year prior; a reduced risk was also observed among older adults and those with prolonged IBD-related hospitalizations. Conflict of interest: Faye, Adam: Consulting/Educational funding from: AbbVie, Takeda, Eli Lilly Barnes, Edward: Consulting/Educational funding from: AbbVie, Takeda, Eli Lilly Sandri, Anastasia: No conflict of interest Allin, Kristine: Currently an epidemiologist at Novo Nordisk Jess, Tine: Personal Fees: Consultancy for Ferring, Pfizer, Johnson & Johnson