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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Preoperative performance status was associated with postoperative fatal complications in elderly patients with refractory ulcerative colitis
Yuki Horio, Motoi Uchino, Yusuke Tomoo, Kazunori Nomura, Kentaro Nagano, Kurando Kusunoki, Ryuichi Kuwahara, Kei Kimura, Toshiyuki Sato, Kozo Kataoka, Masataka Igeta, Shinichiro Shinzaki, Masataka Ikeda, Hiroki Ikeuchi
Yuki Horio, Motoi Uchino, Yusuke Tomoo, Kazunori Nomura, Kentaro Nagano, Kurando Kusunoki, Ryuichi Kuwahara, Kei Kimura, Kozo Kataoka, Masataka Ikeda, Hiroki Ikeuchi, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
Toshiyuki Sato, Shinichiro Shinzaki, Department of Gastroenterology, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
Masataka Igeta, Department of Biostatistics, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
Author contributions: Horio Y was responsible for conception and design of the study; acquisition, analysis, and interpretation of data; and drafting of the article; Igeta M was responsible for analysis and interpretation of data; Tomoo Y, Nomura K, Nagano K, Kusunoki K, Kuwahara R, Kimura K, Kataoka K, and Sato T were responsible for conception and design of the study; acquisition, analysis, and interpretation of data; Uchino M, Shinzaki S, Ikeda M, and Ikeuchi H were responsible for acquisition of data, drafting or critical revision of the article for important intellectual content, and final approval.
Institutional review board statement: All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All study protocols were approved by the institutional review board of Hyogo Medical University (No. 3811).
Informed consent statement: Informed consent and agreement for the use of patient data were obtained before surgery was commenced. Written informed consent was obtained using the opt-out method. An opt-out informed consent protocol was used for the use or collection of participant data for research purposes. This consent procedure was reviewed and approved by the institutional review board of Hyogo Medical University (approval number: 3811; date of decision: June 18, 2021).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: sharing statement: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yuki Horio, MD, PhD, Lecturer, Department of Gastroenterological Surgery, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya 663-8501, Hyogo, Japan.
yu-horio@hyo-med.ac.jp
Received: May 8, 2025
Revised: May 19, 2025
Accepted: June 12, 2025
Published online: August 27, 2025
Processing time: 110 Days and 6.6 Hours
BACKGROUND
Elderly patients with refractory ulcerative colitis (UC) have a poor prognosis, and timely surgical intervention should not be delayed. However, with the advent of biologics, therapy has become more complex, and there are no clear criteria for the timing of surgical conversion.
AIM
To investigate the risk factors for postoperative complications in elderly patients with UC.
METHODS
Elderly patients (≥ 60 years old) with refractory UC who underwent colectomy at Hyogo Medical University between April 2012 and March 2024 were included in this study. Fatal complications included life-threatening complications requiring intensive care unit management and death. The primary outcome was defined by possible risk factors for fatal complications in older patients with refractory UC.
RESULTS
A total of 191 elderly patients with UC were analyzed in this series. The rate of fatal complications was 18/191 (9.4%), and the most common complication was pneumonia due to disuse syndrome. Body mass index (BMI) < 17 kg/m2 [odds ratio (OR) = 4.08, 95% confidence interval (95%CI): 1.19-13.97, P = 0.02] and Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥ 3 (OR = 14.5, 95%CI: 3.43-61.64, P < 0.01) were identified as independent risk factors for fatal complications.
CONCLUSION
Among the elderly patients with refractory UC, the risk factors for fatal complications were low BMI and ECOG-PS score. Prompt surgical intervention is recommended before the patient loses weight or has difficulty walking. These factors may allow for early surgical decision-making before patients become debilitated.
Core Tip: This study identified low body mass index (< 17 kg/m²) and poor Eastern Cooperative Oncology Group performance status (≥ 3) as independent risk factors for fatal postoperative complications in elderly patients with refractory ulcerative colitis. The most common fatal complication was pneumonia due to disuse syndrome. These findings emphasize the importance of early surgical intervention before significant functional decline or weight loss occurs. In the era of complex biologic therapies, these simple, clinically assessable markers offer practical guidance for timely surgical decision-making in high-risk elderly patients.
