Nicholas P McKenna1, Amy E Glasgow2, Robert R Cima3, Elizabeth B Habermann4. 1. Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA. Electronic address: Mckenna.nicholas@mayo.edu. 2. The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA. 3. Division of Colon and Rectal Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA. 4. Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA.
Abstract
BACKGROUND: Organ space infection (OSI) after ileal pouch anal anastomosis (IPAA) is a devastating complication. The aim of this was study was to determine separately risk factors for OSI after total proctocolectomy (TPC) with IPAA and completion proctectomy (CP) with IPAA. METHODS: 4049 patients with a diagnosis of chronic ulcerative colitis undergoing TPC with IPAA or CP with IPAA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Primary outcome was an OSI within 30 days of surgery. Multivariable analyses were conducted for the development of OSI after each operation. RESULTS: For TPC with IPAA, urgent surgery (OR: 2.0, p < 0.01) and obesity (OR: 1.6, p < 0.01) were independent risk factors for OSI. Operation length of 275 + minutes (versus <170 min; OR: 2.2, p = 0.02) was predictive of OSI after CP with IPAA. CONCLUSION: Risk factors for OSI differed between the operations. This highlights the importance of the consideration of the physiologic status of the patient when deciding to perform TPC with IPAA or subtotal colectomy with ileostomy initially.
BACKGROUND: Organ space infection (OSI) after ileal pouch anal anastomosis (IPAA) is a devastating complication. The aim of this was study was to determine separately risk factors for OSI after total proctocolectomy (TPC) with IPAA and completion proctectomy (CP) with IPAA. METHODS: 4049 patients with a diagnosis of chronic ulcerative colitis undergoing TPC with IPAA or CP with IPAA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Primary outcome was an OSI within 30 days of surgery. Multivariable analyses were conducted for the development of OSI after each operation. RESULTS: For TPC with IPAA, urgent surgery (OR: 2.0, p < 0.01) and obesity (OR: 1.6, p < 0.01) were independent risk factors for OSI. Operation length of 275 + minutes (versus <170 min; OR: 2.2, p = 0.02) was predictive of OSI after CP with IPAA. CONCLUSION: Risk factors for OSI differed between the operations. This highlights the importance of the consideration of the physiologic status of the patient when deciding to perform TPC with IPAA or subtotal colectomy with ileostomy initially.
Authors: William Y Luo; Stefan D Holubar; Liliana Bordeianou; Bard C Cosman; Roxanne Hyke; Edward C Lee; Evangelos Messaris; Julia Saraidaridis; Jeffrey S Scow; Virginia O Shaffer; Radhika Smith; Randolph M Steinhagen; Florin Vaida; Samuel Eisenstein Journal: Am J Surg Date: 2020-06-12 Impact factor: 2.565