Preoperative performance status was associated with postoperative fatal complications in elderly patients with refractory ulcerative colitis.

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.