TY - JOUR
T1 - Pouch Failures Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis
AU - Mark-Christensen, Anders
AU - Erichsen, Rune
AU - Brandsborg, Søren
AU - Rønne Pachler, Frederik
AU - Nørager, Charlotte Buchard
AU - Johansen, Niels
AU - Pachler, Jørn Helmut
AU - Thorlacius-Ussing, Ole
AU - Dilling Kjaer, Mie
AU - Qvist, Niels
AU - Preisler, Louise
AU - Hillingsø, Jens
AU - Rosenberg, Jacob
AU - Laurberg, Søren
N1 - This article is protected by copyright. All rights reserved.
PY - 2018/1
Y1 - 2018/1
N2 - Aim: Ileal pouch–anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. Method: The study included 1991 patients with ulcerative colitis who underwent ileal pouch–anal anastomosis in Denmark in the period 1980–2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1–5 cases per year; low, 6–10; intermediate 11–20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis. Results: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10–1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11–2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26–4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy. Conclusion: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch–anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.
AB - Aim: Ileal pouch–anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. Method: The study included 1991 patients with ulcerative colitis who underwent ileal pouch–anal anastomosis in Denmark in the period 1980–2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1–5 cases per year; low, 6–10; intermediate 11–20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis. Results: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10–1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11–2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26–4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy. Conclusion: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch–anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.
KW - Journal Article
KW - pouch failure
KW - restorative proctocolectomy
KW - Ileal pouch–anal anastomosis
KW - ulcerative colitis
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Proportional Hazards Models
KW - Male
KW - Incidence
KW - Young Adult
KW - Postoperative Complications/epidemiology
KW - Denmark
KW - Adult
KW - Female
KW - Registries
KW - Colitis, Ulcerative/surgery
KW - Colonic Pouches/adverse effects
KW - Cohort Studies
KW - Proctocolectomy, Restorative/adverse effects
U2 - 10.1111/codi.13802
DO - 10.1111/codi.13802
M3 - Journal article
C2 - 28667683
VL - 20
SP - 44
EP - 52
JO - Colorectal Disease
JF - Colorectal Disease
SN - 1462-8910
IS - 1
ER -