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O'Connor E, Sugarman I, Patel Y, Jaffray B. Severity of complications following restorative proctocolectomy in children is related to staging not diagnosis. J Pediatr Surg 2021; 56:1330-1334. [PMID: 32972742 DOI: 10.1016/j.jpedsurg.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/25/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Restorative proctocolectomy (RPC) is performed using a variety of staged procedures for several diseases. Our aim was to assess whether the severity of complications, classified according to Clavien-Dindo, was related to the diagnosis or the procedure. METHODS A consecutive series of children receiving an ileoanal pouch was prospectively recorded. Complications were scored by two blinded observers. Major complications were Clavien-Dindo ≥3b. Procedures were classified as: colectomy, proctectomy and pouch or proctocolectomy and pouch. Diagnoses were classified as: ulcerative colitis, familial adenomatous polyposis or other: idiopathic constipation, total colonic Hirschsprung's disease, juvenile polyposis, Crohn's colitis, fibrosing colonopathy or necrotising enterocolitis. RESULTS 128 children underwent 191 procedures: 61 colectomies, 63 proctectomies and 67 proctocolectomies. 84 children had ulcerative colitis, 20 had FAP and 24 had other indications. Major complications were significantly more likely with proctocolectomy (16/67, 24%) than with either colectomy (4/61, 7%) or proctectomy (8/63, 13%), p = 0.01. There was no association between diagnosis and major complications: ulcerative colitis (18/133, 14%), FAP (5/20, 25%), other (5/38, 13%) p = 0.4. There was no increase in major complications following proctectomy if a major complication had occurred during prior colectomy. Overall, 15% of procedures experienced a major complication. 6/9 stoma related complications required operative intervention. CONCLUSIONS The severity of complications after RPC in children is related to use of a two stage rather than three stage sequence of surgery, not the underlying diagnosis. TYPE OF STUDY Case control study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Ian Sugarman
- The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Yatin Patel
- The Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Bruce Jaffray
- The Great North Children's Hospital, Newcastle upon Tyne, UK.
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Krauthammer A, Tzivinikos C, Assa A, Miele E, Strisciuglio C, Urlep D, Serban ED, Singh A, Winter HS, Russell RK, Hojsak I, Malham M, Navas-López VM, Croft NM, Lee HM, Ledder O, Shamasneh I, Hussey S, Huynh HQ, Wine E, Shah N, Sladek M, de Meij TG, Romano C, Dipasquale V, Lionetti P, Afzal NA, Aloi M, Lee K, Martín-de-Carpi J, Yerushalmy-Feler A, Subramanian S, Weiss B, Shouval DS. Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis- A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN. J Crohns Colitis 2019; 13:1518-1526. [PMID: 31120524 DOI: 10.1093/ecco-jcc/jjz092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Acute severe colitis [ASC] is associated with significant morbidity in paediatric patients with ulcerative colitis [UC]. Most outcome studies in ASC since tumour necrosis factor alpha [TNFα] antagonists became available have focused on the first year after admission. The aim of this study was to characterise the longer-term outcomes of paediatric patients admitted with ASC. METHODS This retrospective study was conducted in 25 centres across Europe and North America. Data on patients with UC aged <18 years, admitted with ASC (defined as paediatric ulcerative colitis activity index [PUCAI] score ≥65) between 2009 and 2011, were collected at discharge and 1, 3 and 5 years after admission. The primary outcome was colectomy-free rates at each time point. RESULTS Of the 141 patients admitted with ASC, 137 [97.1%] were treated with intravenous corticosteroids. Thirty-one [22.6%] patients were escalated to second-line therapy, mainly to infliximab. Sixteen patients [11.3%] underwent colectomy before discharge. Long-term follow-up showed colectomy-free rates were 71.3%, 66.4% and 63.6% at 1, 3 and 5 years after initial ASC admission, respectively, and were similar across different age groups. Sub-analysis of colectomy rates in patients with new-onset disease [42.5% of the cohort] yielded similar results. In a multivariate analysis, use of oral steroids in the 3 months before admission, erythrocyte sedimentation rate >70 mm/h, and albumin <2.5 g/dL, were significantly associated with 5-year colectomy risk. CONCLUSIONS High colectomy rates were demonstrated in paediatric UC patients admitted with ASC. Additional studies are required to determine whether intensification of anti-TNFα treatment, close therapeutic drug monitoring, and use of new drugs alter this outcome.
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Affiliation(s)
- Alex Krauthammer
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christos Tzivinikos
- Department of Paediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK
| | - Amit Assa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Centre of Israel, Petah Tiqwa, Israel
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania, "Luigi Vanvitelli"Naples, Italy
| | - Darja Urlep
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Elena Daniela Serban
- Second Department of Paediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Avantika Singh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Harland S Winter
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mikkel Malham
- Paediatric Department, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Nicholas M Croft
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Huey Miin Lee
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Oren Ledder
- Juliet Keidan Instutute of Pediatric Gastroenterology, Shaare Zedek Medical Centre, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ibrahim Shamasneh
- Juliet Keidan Instutute of Pediatric Gastroenterology, Shaare Zedek Medical Centre, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Seamus Hussey
- National Children's Research Centre, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Hien Q Huynh
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Eytan Wine
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Neil Shah
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital London, London, UK
| | - Margaret Sladek
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland
| | - Tim G de Meij
- Department of Paediatric Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Paolo Lionetti
- Gastroenterology Unit, University of Florence, Department of "NEUROFARBA": Section of Child's Health, "Anna Meyer" Children's Hospital, Florence, Italy
| | - Nadeem A Afzal
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Marina Aloi
- Sapienza University of Rome, Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Rome, Italy
| | - Kwangyang Lee
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| | - Javier Martín-de-Carpi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anat Yerushalmy-Feler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv, Israel
| | - Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool University Hospital and University of Liverpool, Liverpool, UK
| | - Batia Weiss
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror S Shouval
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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