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. 2024 Aug 1;30(8):1326-1333.
doi: 10.1093/ibd/izad177.

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

Edward L Barnes  1   2 , Scott Esckilsen  3 , Jean Ashburn  4 , Amy Barto  5 , Richard Bloomfeld  6 , Ashley Cairns  4 , Kurren Mehta  7 , Pooja Patel  7 , Jennifer Dziwis  6   7 , Michael S Dunn  8 , Reza Rahbar  9 , Timothy S Sadiq  9 , John S Hanson  10 , Hans H Herfarth  1   2
Affiliations

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

Edward L Barnes et al. Inflamm Bowel Dis. .

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.

Keywords: J-pouch; ileal pouch–anal anastomosis; outcomes research; pouchitis; readmission.

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Conflict of interest statement

E.L.B. has served as a consultant for AbbVie, Lilly, and Target RWE. H.H.H. has served as a consultant for Alivio, AMAG, BMS, ExeGI Finch, Gilead, Janssen, Lycera, Merck, Otsuka, Pfizer, PureTech, and Seres; and received research support from Pfizer and Artizan Biosciences. All other authors have no relevant disclosures.

References

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    1. Barnes EL, Lightner AL, Regueiro M.. Peri-operative and post-operative management of patients with Crohn’s disease and ulcerative colitis. Clin Gastroenterol Hepatol. 2020;18(6):1356-1366. - PubMed
    1. Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222(2):120-127. - PMC - PubMed
    1. Barnes EL, Allin KH, Iversen AT, Herfarth HH, Jess T.. Increasing incidence of pouchitis between 1996 and 2018: a population-based Danish Cohort Study. Clin Gastroenterol Hepatol. 2023;21(1):192-199.e7. - PMC - PubMed
    1. Barnes EL, Kochar B, Jessup HR, Herfarth HH.. The incidence and definition of Crohn’s disease of the pouch: a systematic review and meta-analysis. Inflamm Bowel Dis. 2019;25(9):1474-1480. - PMC - PubMed

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