453 The Optimal Timing of Colectomy for Acute Severe Ulcerative Colitis

Abstract Aim Acute severe ulcerative colitis (ASUC) is a medical emergency which, if left untreated, can be fatal. Some cases require colectomy. The timing of this operation is important to reduce post-operative morbidity. The primary study aim is to assess whether the timing of this operation impacts upon post-operative outcome. The secondary aim of this study is to determine whether pre-operative blood albumin level may be able to predict post-operative complication rates. Method All patients who underwent colectomy and ileostomy formation for ASUC at Bristol Royal Infirmary between 2010-2020 were identified. Patient demographic information, duration of pre-operative hospital stays, blood results and post-operative complications up until the most recent follow up were recorded. Patients undergoing elective colectomy for ulcerative colitis were analysed separately. Results Twenty-one ASUC admissions were identified who were all treated with intravenous steroids for a median of 9 (range 1-18) days before colectomy. 16 patients (76%) received either ciclosporin or infliximab rescue therapies. Median admission CRP was 41 (range 4-231). Median admission blood albumin was 29 (range 16-38). <30-day and >30-day post-operative complication rates were 52% (11/21) and 25% (5/20) respectively. Conclusions Previous literature shows significant association between the length of pre-operative medical therapy and post-operative complications. Surgeons can learn from them, so far, negative findings of our study. A surgeon’s own clinical judgement is the most important factor in the decision of when to take an ASUC patient to theatre. Biomarkers can aid a decision but cannot be used as a solitary justifier for the timing of colectomy.