Objectives: Data describing the incidence and risk factors for colectomy in pediatric ulcerative colitis (UC) is inconsistent. Our aim was to describe the colectomy rate and to identify risk factors associated with colectomy in a large cohort of children with UC with long term follow up.
Methods: We performed a retrospective chart review of pediatric UC cases that were diagnosed at Schneider Children`s Medical Center of Israel between 1981 to 2013. Potential predictors for colectomy including age at diagnosis, gender, disease extent, severity indices and different therapeutic regimens during disease course were assessed.
Results: Of 188 patients with pediatric onset UC, 34 (18%) underwent colectomy. Median follow-up was 6.9 years (range, 1-30). Kaplan – Meier survival estimates of the cumulative probability for colectomy were 4% at one year and 17% at 10 years from diagnosis. Multivariate Cox models showed that male gender (HR 4.2, P = 0.001) and severe disease at diagnosis reflected by Pediatric Ulcerative Colitis Activity Index (PUCAI) score ≥ 65 (HR 8.9, P < 0.001) were associated with increased risk for colectomy. Age, disease extent, ethnicity, family history of inflammatory bowel disease, early introduction of immunomodulators, treatment with anti-tumor necrosis factor ɑ agent or diagnosis prior to the year 2000 did not affect the risk of colectomy.
Conclusions: Male sex and higher PUCAI score at diagnosis are independent risk factors for colectomy while anti-tumor necrosis factor ɑ treatment and diagnosis during the "biologic era" are not associated with diminished long-term surgical risk.
