Trends in surgical treatment for ulcerative colitis in the era of biologics – A population-based study using German diagnosis-related groups data

Background: The development of biologics has significantly advanced treatment of ulcerative colitis. However, their impact on the number of surgical cases and complication rates has not been clearly established. The aim of this study was first to describe trends and case numbers for surgery in the era of advanced therapies and second to analyze developments in surgical techniques and complications during that era. Methods: A population-based analysis was performed on nationwide German hospital discharge data (diagnosis-related groups) to assess temporal trends in surgery for ulcerative colitis from 2008 to 2018. All inpatients with a diagnosis of ulcerative colitis (International Classification of Diseases, Tenth Revision, codes K51.0-K51.9) were included. Data from the German Federal Institute for Drugs and Medical Devices were examined to characterize the biologics market in Germany. Results: The study included 522,705 in-hospital cases with a diagnosis of ulcerative colitis. An increase in marketing authorizations for biologics was noted during the study period (1,227 cumulative total in 2021). Partial colon resections declined in absolute numbers (631 in 2008 vs 585 in 2018; P = .003) and relative proportion (1.5% to 1.1%; P < .00001). Conversely, rates of colectomies increased (0.43% to 0.95%; P < .00001) and proctocolectomy rates were stable (0.93% in 2008 and 1.1% in 2018; P = .249). Within the study period the rate of minimally invasive surgery increased (14.5% to 65.6%), with a significant decrease in conversion rates (15.4% to 7.6%; P = .00395). Complication rates were significantly lower for laparoscopic compared with open surgery (17% ± 4.6% vs 31.1% ± 2.0%; odds ratio, 0.46, 95% confidence interval, 0.41–0.52; P < .00001). Conclusion: Despite the increasing availability of biologic therapies, the rates of colectomy and proctocolectomy for ulcerative colitis did not decrease during the study period.