MSS12: RESTORATIVE PROCTOCOLECTOMY FOR SEVERE AND REFRACTORY ULCERATIVE COLITIS: A MEANS FOR RETENTION IN ACTIVE-DUTY US MILITARY
Alec Donohue, DO; Dwayne Nelson, PhD; Ilya Latyshenko, MD; Shaun Brown, DO; Womack Army Medical Center
Background: Ulcerative colitis is a chronic inflammatory bowel disease that affects military service members with the possibility of negatively impacting their careers. Current military standards preclude the retention of active-duty service members with severe or refractory disease which require biologics or have resulted in an end-ileostomy.
Objective: Investigate the impact of restorative proctocolectomy on medical and other service discharges among active-duty ulcerative colitis patients.
Design: Retrospective cohort study.
Settings: Data from the Medical Assessment and Readiness System at Womack ArmyMedical Center, covering January 2011 to June 2022.
Patients: Active-duty US military members diagnosed with ulcerative colitis in 2012-2017.
Interventions: Restorative proctocolectomy.
Main Outcome Measures: Medical and nonmedical discharges.
Results: Among 3809 ulcerative colitis patients, restorative proctocolectomy was performed in 1.5%. Amongst those undergoing operative intervention, 51% were able to avoid medical discharge (19% remaining on active duty after the observational period and 32% discharged for nonmedical reasons). Restorative proctocolectomy was associated with a higher risk of medical discharge (aHR: 2.11; 95% CI: 1.45 to 3.09; P < 0.001) compared to non-surgical ulcerative colitis patients. Service branch, tobacco use, BMI, age, and pay grade demonstrated statistical significance regarding medical discharge risk. No patients changed their military occupational specialty.
Conclusion: Restorative proctocolectomy offers a pathway for continued military service for ulcerative colitis patients. Those undergoing operative intervention were shown to have a higher rate of medical discharge compared to the overall ulcerative colitis population. However, those being offered operative intervention are those with the most severe disease, often failing medical management, and are likely at a higher risk for medical discharge given repeated attempts at immunomodulating therapy. Additionally, service branch, lifestyle factors, and demographics significantly influence medical discharge risk. Future research should explore additional contributing factors and functional outcomes to better understand this pathway for service continuation.