Extensive Colitis and Smoking Are Associated With Postoperative Complications Within 30 Days of Ileal Pouch–Anal Anastomosis

• Published in: Inflammatory bowel diseases Vol. 30; no. 8; pp. 1326 - 1333
• Main Authors: Barnes, Edward L, Esckilsen, Scott, Ashburn, Jean, Barto, Amy, Bloomfeld, Richard, Cairns, Ashley, Mehta, Kurren, Patel, Pooja, Dziwis, Jennifer, Dunn, Michael S, Rahbar, Reza, Sadiq, Timothy S, Hanson, John S, Herfarth, Hans H
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-08-2024
• Subjects: Adult; Clinical Research; Colitis, Ulcerative - surgery; Colonic Pouches - adverse effects; Female; Humans; Male; Middle Aged; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctocolectomy, Restorative - adverse effects; Registries; Retrospective Studies; Risk Factors; Smoking - adverse effects; Smoking - epidemiology; outcomes research; ileal pouch–anal anastomosis; readmission; J-pouch; pouchitis
• ISSN: 1078-0998; 1536-4844; 1536-4844
• DOI: 10.1093/ibd/izad177

Abstract
Background
Our understanding of outcomes after proctocolectomy with ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC) is largely based on analyses of selected populations. We created a state-level registry to evaluate the epidemiology of IPAA surgery and pouch-related outcomes across the major healthcare systems performing these surgeries in our state.
Methods
We created a retrospective cohort of all patients undergoing restorative proctocolectomy with IPAA for UC at 1 of 4 centers between January 1, 2018, and December 31, 2020. The primary outcomes of this study were the rate of complications and all-cause readmissions within the first 30 days of the final stage of IPAA surgery.
Results
During the study period, 177 patients underwent IPAA surgery with 66 (37%) experiencing a complication within 30 days. After adjusting for the number of stages in IPAA surgery, patients with extensive UC (odds ratio, 3.61; 95% confidence interval, 1.39-9.33) and current or former smokers (odds ratio, 2.98; 95% confidence interval, 1.38-6.45) were more likely to experience a complication. Among all patients, 57 (32%) required readmission within 30 days. The most common reasons for readmission were ileus/small bowel obstruction (22%), peripouch abscess (19%), and dehydration (16%).
Conclusion
In this first state-level examination of the epidemiology of IPAA for UC, we demonstrated that the complication rate after IPAA for UC was 37%, with one-third of patients being readmitted within 30 days. Extensive disease at the time of colectomy appears to be an indicator of more severe disease and may portend a worse prognosis after IPAA.