Restorative surgery for ulcerative colitis in the elderly: an analysis of ileal pouch-anal anastomosis procedures from the American College of Surgeons National Surgical Quality Improvement Program

Pellino, Gianluca; Paula, Thais Reif de; Lawlor, Garrett; Keller, Deborah S.

doi:10.1007/s10151-020-02315-5

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…5 The results of the current study largely confirm the risk factors identified by previous studies in a nationwide US population. 13,14 However, unlike the Swedish study, we did not find that socioeconomic status was significantly associated with IPAA. This is likely because our study population included only patients with continuous commercial insurance, suggesting that this coverage may provide a protective effect against differences in income and education.…”

Section: Discussioncontrasting

confidence: 99%

Factors Associated With Performing Ileal Pouch-Anal Anastomosis After Total Colectomy for Ulcerative Colitis

Chen,

Pak,

Agala

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Ileal pouch-anal anastomosis is considered the procedure of choice for restorative surgery after total colectomy for ulcerative colitis. Previous studies have examined the rate of ileal pouch-anal anastomosis within individual states, but not at the national level in the United States. OBJECTIVE: Assess the rate of ileal pouch-anal anastomosis after total colectomy for ulcerative colitis in a national population and identify factors associated with ileal pouch-anal anastomosis. DESIGN: This was a retrospective cohort study. SETTINGS: This study was performed in the United States. PATIENTS: Patients who were ≥18 years old who underwent total colectomy between 2009 and 2019 for a diagnosis of ulcerative colitis were identified within a commercial database. This database excluded patients with public insurance, including all patients >65 years old with Medicare. MAIN OUTCOME MEASURES: The primary outcome was ileal pouch-anal anastomosis. Multivariable logistic regression was used to assess the association between covariates and likelihood of undergoing ileal pouch-anal anastomosis. RESULTS: In total, 2,816 patients were included of whom 1414 (50.2%) underwent ileal pouch-anal anastomosis, 928 (33.0%) underwent no further surgery, and 474 (16.8%) underwent proctectomy with end ileostomy. Younger age, lower comorbidities, elective case, and laparoscopic approach in the initial colectomy were significantly associated with ileal pouch-anal anastomosis, but not socioeconomic status. LIMITATIONS: This retrospective study included only patients with commercial insurance. CONCLUSIONS: A total of 50.2% of patients undergo ileal pouch-anal anastomosis and younger age, lower co-morbidities, and elective cases are associated with a higher rate of ileal pouch-anal anastomosis placement. This emphasizes the importance of ensuring follow-up with colorectal surgeons to provide the option of restorative surgery, especially for patients undergoing urgent or emergent colectomies. See Video Abstract.

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Section: Discussioncontrasting

confidence: 99%

Factors Associated With Performing Ileal Pouch-Anal Anastomosis After Total Colectomy for Ulcerative Colitis

Chen,

Pak,

Agala

et al. 2024

Diseases of the Colon &Amp; Rectum

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“…This fits the recommendations of the guidelines [9]. The choice for a three-staged concept in cases with a severe UC and high-dose immunosuppression results in fewer perioperative complications and better longterm outcomes [18][19][20]. We interpreted the higher degree of proctitis in three-staged IPAA as an indicator of the overall higher activity of the disease in those patients, which led to the decision for a three-staged concept.…”

Section: Discussionsupporting

confidence: 58%

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

Frese

Gröne

Lauscher

et al. 2022

Int J Colorectal Dis

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Background Inflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes. Methods Three hundred thirty-four UC patients with primary IPAA were included in this retrospective case–control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (“NOP”), mild to medium proctitis (“MIP”), and severe proctitis (“SEP”). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan–Meier analysis was performed in the event of pouch failure. Results The prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0–6.9) years among NOP, and 1.2 (0.5–2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure. Conclusion Proctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure.

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“…Our study found that, from 2016 to 2020, a greater proportion of TPC‐IPAAs were performed nearly every year (except 2019) than CP‐IPAAs. This was similarly observed in a study of elderly patients undergoing TPC‐IPAA or CP‐IPAA from 2012 to 2016 [14]. In contrast, one study showed a greater proportion of CP‐IPAAs compared to TPC‐IPAAs from 2005 to 2011 [13].…”

Section: Discussionsupporting

confidence: 55%

“…As such, we do not know whether patients had presented as an emergency during another admission prior to their CP‐IPAA. Knowing this to be an important limitation, we not only categorized TPC‐IPAA and CP‐IPAA patients as described in published studies [11–14], but we also excluded patients who underwent emergency operations and performed separate multivariable analyses for each IPAA staged approach. Because we could only define CP‐IPAA patients at the time of their elective pouch surgery and not from their previous hospital admission during which they may have undergone total abdominal colectomy with end ileostomy, we are unable to ascertain whether the procedure done prior to their elective pouch surgery was performed as an emergency or electively, and some of these patients may not have been included in our final study population, thereby yielding a smaller sample size in the CP‐IPAA cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Patients ≥18 years of age diagnosed with UC who underwent TPC‐IPAA or CP‐IPAA were included in this study. UC diagnoses were identified using the International Classification of Diseases 9th and 10th Revision codes, and IPAA procedures were identified using Current Procedural Terminology codes and categorized into TPC‐IPAA or CP‐IPAA approaches, as described in previous studies [11–14] (Table S1). Patients were excluded if they met any of the following criteria: (a) diagnosis of colon, rectal or metastatic cancer; (b) underwent emergency surgery (to ensure that our study population was of medically refractory chronic UC patients); (c) were transferred from an acute care facility, emergency department or outside hospital prior to the procedure; (d) had American Society of Anesthesiologists (ASA) classification V or missing classification; and/or (e) non‐open, non‐laparoscopic or non‐robotic case (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

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National trends and outcomes of total proctocolectomy and completion proctectomy ileal pouch−anal anastomosis procedures for ulcerative colitis

Chen,

Radomski,

Stem

et al. 2024

Colorectal Disease

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AimThe purpose of this study is to assess US operative trends and outcomes of ulcerative colitis (UC) patients undergoing total proctocolectomy with ileal pouch−anal anastomosis (TPC‐IPAA) or completion proctectomy with IPAA (CP‐IPAA).MethodsAdult UC patients who underwent TPC‐IPAA or CP‐IPAA were analysed retrospectively using the 2016–2020 American College of Surgeons National Surgical Quality Improvement Program database. Factors associated with 30‐day overall and serious morbidity were identified using multivariable logistic regression.ResultsA total of 1696 patients were identified, with 958 patients (56.5%) undergoing TPC‐IPAA and 738 (43.5%) undergoing CP‐IPAA. A greater proportion of TPC‐IPAAs were performed each year (except in 2019) compared to CP‐IPAAs over the study period (P trend <0.001). Unadjusted analysis showed comparable rates of overall (20.8% vs. 24.4%, P = 0.076) and serious morbidity (14.3% vs. 12.7%, P = 0.352) between TPC‐IPAA and CP‐IPAA patients. Robotic TPC‐IPAA had no differences in complications compared to laparoscopic and open approaches. Robotic CP‐IPAA had higher anastomotic leak rates and longer hospital length of stay compared to laparoscopic and open approaches. Obesity was associated with increased odds of overall and serious morbidity for patients who underwent TPC‐IPAA. Steroid/immunosuppressive therapy was associated with increased odds of overall and serious morbidity for patients who underwent CP‐IPAA.ConclusionsObese patients should be informed of their increased morbidity risk and offered counselling on weight loss prior to surgery when feasible. Patients on steroid/immunosuppressive therapy within 30 days preoperatively should not undergo CP‐IPAA or should delay surgery until they can be safely off those medications.

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Restorative surgery for ulcerative colitis in the elderly: an analysis of ileal pouch-anal anastomosis procedures from the American College of Surgeons National Surgical Quality Improvement Program

Cited by 7 publications

References 30 publications

Factors Associated With Performing Ileal Pouch-Anal Anastomosis After Total Colectomy for Ulcerative Colitis

Factors Associated With Performing Ileal Pouch-Anal Anastomosis After Total Colectomy for Ulcerative Colitis

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

National trends and outcomes of total proctocolectomy and completion proctectomy ileal pouch−anal anastomosis procedures for ulcerative colitis

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