BACKGROUND: Disease modifying anti-inflammatory bowel disease drugs (DMAIDs), such as infliximab, have altered treatment of inflammatory bowel disease. Despite increasing availability of disease modifying anti-inflammatory bowel disease drugs, many individuals with inflammatory bowel disease still require surgical resection and the role of disease modifying anti-inflammatory bowel disease drugs in delaying colectomy are limited. OBJECTIVE: To assess use patterns of disease modifying anti-inflammatory bowel disease drugs use preceding colectomy for refractory inflammatory bowel disease. DESIGN: Retrospective analysis of institutional data. SETTING: Academic tertiary medical center from 2003-2022. PATIENTS: Patients with Crohn's disease or ulcerative colitis who underwent total abdominal colectomy or proctocolectomy for medically refractory disease. MAIN OUTCOME MEASURES: Number and type of disease modifying anti-inflammatory bowel disease drugs used prior to colectomy and use of disease modifying anti-inflammatory bowel disease drugs over time. RESULTS: A total of 487 patients met inclusion criteria, most of whom had ulcerative colitis (77.8%) and were male (57.1%), mean age at diagnosis of 32.1 years. 280 patients' first DMAID was an anti-TNF agent. We found no significant difference in time from diagnosis to colectomy when comparing those who initially received an anti-tumor necrosis factor versus a non-anti-tumor necrosis agent (8.29 years vs. 8.86 years, p = 0.39). Linear regression demonstrated that, with each decade, patients used about 1.5 additional disease modifying anti-inflammatory bowel disease drugs (p < 0.01) prior to surgery. Mean time between diagnosis and colectomy was 8.6 years. Accelerated failure time modeling demonstrated each additional DMAID was associated with a non-significant 5% increase in time between diagnosis and colectomy (1.05 [0.96-1.13], p = 0.25). LIMITATIONS: Single-center, retrospective. CONCLUSIONS: Over a 20-year period, patients with inflammatory bowel disease-associated colitis who ultimately required colectomy received increasing numbers of disease modifying anti-inflammatory bowel disease drugs; however, each additional disease modifying anti-inflammatory bowel disease drugs used did not significantly delay time to colectomy, nor did initial non-anti-TNF agent choice. These data suggest that a subset of patients are using increasing numbers of disease modifying anti-inflammatory bowel disease drugs that do not afford them meaningful time in delaying colectomy. See Video Abstract.