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Patients with severe ulcerative colitis (UC) are usually treated with aggressive medical therapy; colectomy is reserved for patients who fail to respond to medical treatment. Patients who require emergency surgery have a high mortality rate, but in two recent European studies, elective surgery in patients with severe disease was associated with lower mortality compared with medical therapy.
In a retrospective cohort study, investigators examined mortality in U.S. patients with Medicare or Medicaid insurance and advanced UC who received elective colectomy (830 patients) or medical therapy (7541 matched controls). Advanced UC was defined as hospitalization for UC, ≥2 prescriptions for corticosteroids within 90 days, or use of an immunosuppress…