Weimin Xu1, Hairong Ye2, Yilian Zhu3, Wenjun Ding4, Jihong Fu5, Long Cui6, Peng Du7. 1. Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: xuweimin@sjtu.edu.cn. 2. Department of Anesthesia, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: yehairong@xinhuamed.com.cn. 3. Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: yoursmile@sjtu.edu.cn. 4. Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: dingwenjun@xinhuamed.com.cn. 5. Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: fujihong@xinhuamed.com.cn. 6. Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: cuilong@xinhuamed.com.cn. 7. Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: dupeng@xinhuamed.com.cn.
Abstract
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is recommended for patients with ulcerative colitis (UC) in terms of surgical treatment. Measuring surgical complications of IPAA and long-term quality of life (QOL) are important to achieve an acceptable risk/benefit ratio for patients with UC. MATERIALS AND METHODS: Patients with UC who underwent total proctocolectomy (TPC) with IPAA from February 2008 to July 2016 at our institute were included. Early surgical complications were defined as mechanical/infectious events within one month after IPAA. Assessment of QOL was performed using the Cleveland Global Quality of Life instrument (CGQL), with 50% improvement as a cut-off value. Demographic and clinical variables were compared with univariable analysis and step-wise logistic regression models were also performed. RESULTS: A total of 58 eligible patients had a median follow-up time of 78.5 months [interquartile range (IQR), 34.4-92.8] from February2008 to March 2017, including 25 cases (43.1%) developed early surgical complications. Age at pouch surgery and excessive blood loss were risk factors associated with early surgical complications (p < 0.05). In multivariate analysis, older age at surgery [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.01-1.1] and significant blood loss (≧400 ml) (OR, 4.31; 95% CI, 1.21-16.87) were contributing factors for developing early surgical complications. The CGQL score was significantly increased after IPAA (0.728 ± 0.151 vs. 0.429 ± 0.173, p < 0.001). Early surgical complications (OR, 5.55; 95%CI, 1.44-21.37), older age at surgery (OR, 1.06; 95% CI, 1.01-1.12) and use of immunomodulatory (OR, 17.50; 95% CI, 1.52-201.39) were associated with poor long-term QOL. CONCLUSION: The study demonstrated that early surgical complications might contribute to develop a poor CGQL score, suggesting intentional control of risk factors associated with early surgical complications should be taken into consideration for patients with UC for pouch surgery.
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is recommended for patients with ulcerative colitis (UC) in terms of surgical treatment. Measuring surgical complications of IPAA and long-term quality of life (QOL) are important to achieve an acceptable risk/benefit ratio for patients with UC. MATERIALS AND METHODS:Patients with UC who underwent total proctocolectomy (TPC) with IPAA from February 2008 to July 2016 at our institute were included. Early surgical complications were defined as mechanical/infectious events within one month after IPAA. Assessment of QOL was performed using the Cleveland Global Quality of Life instrument (CGQL), with 50% improvement as a cut-off value. Demographic and clinical variables were compared with univariable analysis and step-wise logistic regression models were also performed. RESULTS: A total of 58 eligible patients had a median follow-up time of 78.5 months [interquartile range (IQR), 34.4-92.8] from February2008 to March 2017, including 25 cases (43.1%) developed early surgical complications. Age at pouch surgery and excessive blood loss were risk factors associated with early surgical complications (p < 0.05). In multivariate analysis, older age at surgery [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.01-1.1] and significant blood loss (≧400 ml) (OR, 4.31; 95% CI, 1.21-16.87) were contributing factors for developing early surgical complications. The CGQL score was significantly increased after IPAA (0.728 ± 0.151 vs. 0.429 ± 0.173, p < 0.001). Early surgical complications (OR, 5.55; 95%CI, 1.44-21.37), older age at surgery (OR, 1.06; 95% CI, 1.01-1.12) and use of immunomodulatory (OR, 17.50; 95% CI, 1.52-201.39) were associated with poor long-term QOL. CONCLUSION: The study demonstrated that early surgical complications might contribute to develop a poor CGQL score, suggesting intentional control of risk factors associated with early surgical complications should be taken into consideration for patients with UC for pouch surgery.