Samuel Eisenstein, MD, on the Surgeon's Role in Acute Severe Ulcerative Colitis

Dr Eisenstein reviews key reasons to involve a colorectal surgeon early in the care of patients with acute severe ulcerative colitis, rather than waiting until surgery has become a necessity.

Samuel Eisenstein, MD, is a colorectal surgeon with University of California San Diego Health in San Diego, California.

TRANSCRIPT:

Hi, there. I'm Sam Eisenstein. I'm a colon and rectal surgeon from UC San Diego Health, and my talk was entitled "Colorectal Surgery and Acute Severe Ulcerative Colitis, Partners From the Start, Not the Final Call." The main takeaway point from this talk was about engagement of the colon and rectal surgeon and the care of the ulcerative colitis patients prior to the time where surgery has become a necessity. The interaction can be more robust. It allows for a less coercive interaction and allows patients to understand what's involved with surgery so as they're managing their care through time, they can understand what might go into surgery and make the appropriate decisions for their own care.

We covered several topics about optimizing patients prior to surgery, including optimizing nutrition as well as minimizing the risk of complications. There remains controversy in the field about the management of biologics around the time of surgery, and data presented during this talk demonstrated that while biologics do not appear to cause complications of surgery, they can be a marker of severe disease. For example, patients who have failed multiple biologics are likely higher risk for surgery due to the amount of time they have been living with advanced illness and the amount of time that their medications haven't been working.

Similarly, we also discussed management of venous thromboembolism around the time of surgery, keeping in mind that patients with significant ulcerative colitis have up to a 30% risk of perioperative VTE, as well as minimizing narcotics around the time of surgery, as narcotic usage prior to surgery can lead to poor pain outcomes after their procedures. Thank you.