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Introduction Despite advances in medical therapy, a substantial proportion of patients with ulcerative colitis (UC) still require surgery, often early in the disease course. Identifying predictors of early colectomy may help optimise treatment strategies and improve patient outcomes.Methods We conducted a retrospective monocentric observational study including 95 UC patients who underwent surgery, selected from a cohort of 601 patients followed between 2005 and 2025 in a tertiary referral centre. Early surgery was defined as colectomy performed within 12 months of UC diagnosis. Patients operated on for non-UC indications or with incomplete data were excluded. Clinical, endoscopic and biological variables were analysed. Factors associated with early colectomy were assessed using univariate analysis followed by multivariable logistic regression.Results Mean age at diagnosis was 33.6 years (median 32), with a balanced sex ratio (52% male). Extensive disease (E3) was present in 66% of patients, and severe endoscopic activity (Mayo endoscopic score = 3) in 66%. Preoperative corticosteroids were used in 74% of patients, immunomodulators in 36% and anti-TNF therapy in 7%.In multivariable analysis, older age at diagnosis (OR 1.04 per year, 95% CI 1.00–1.09; p = 0.04), severe endoscopic activity (Mayo 3) (OR 1.30, 95% CI 1.02–1.68; p = 0.03), and hypoalbuminaemia <30 g/L (OR 0.85, 95% CI 0.74–0.98; p = 0.02) were independently associated with early colectomy. C-reactive protein levels, haemoglobin, smoking status and corticosteroid exposure were not independently associated with early surgery.Conclusions Early colectomy in UC is primarily driven by disease severity at diagnosis, particularly severe endoscopic inflammation and hypoalbuminaemia. These readily available parameters may help identify patients at high risk of early surgery who could benefit from early treatment optimisation and closer monitoring.