High but decreasing rates of reconstruction after total proctocolectomy for ulcerative colitis, and evidence of a direct volume outcome relationship-Reference-Cited by-同舟云学术

High but decreasing rates of reconstruction after total proctocolectomy for ulcerative colitis, and evidence of a direct volume outcome relationship

Published:2024-03-25 Issue: Volume: Page:
ISSN:1445-1433
Container-title:ANZ Journal of Surgery
language:en
Short-container-title:ANZ Journal of Surgery

Author:

Giddings Hugh L.¹²³^ORCID,Ng Kheng‐Seong¹²⁴,Solomon Michael J.¹²³⁴^ORCID,Steffens Daniel²⁴^ORCID,Van Buskirk Joe⁵⁶,Young Jane²

Affiliation:

1. Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia

2. Surgical Outcomes Research Centre (SOuRCe) Royal Prince Alfred Hospital Sydney New South Wales Australia

3. Institute of Academic Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia

4. Faculty of Medicine and Health, Central Clinical School The University of Sydney Sydney New South Wales Australia

5. Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia

6. Public Health Research Analytics and Methods for Evidence Sydney Local Health District Sydney New South Wales Australia

Abstract

AbstractBackgroundTotal (procto)colectomy is indicated in 15%–20% of ulcerative colitis(UC) patients during their disease course. Reconstruction options to avoid a permanent ileostomy include an ileoanal pouch anastomosis (IPAA) or ileorectal anastomosis (IRA). This study aimed to investigate reconstruction rates using Australian‐based population‐level data, and factors influencing reconstruction.MethodsA retrospective data linkage study of the NSW population over a 19‐year period was performed. Patients with UC who underwent total (procto)colectomy with a minimum of 1‐year follow up were included. The main outcome was reconstruction with either IPAA or IRA. The influence of hospital and patient factors on reconstruction rates was assessed by Cox regression.ResultsOverall, 1047 patients underwent a (procto)colectomy for UC (mean age 45.9 years [SD ± 18.3], 640 [61.1%] male). The 5‐year reconstruction rate was 55% (IPAA 89%). Advanced age, emergent colectomy, higher comorbidity burden, and geographical remoteness were significantly associated with lower reconstruction rates. A lower reconstruction rate was also observed in the most recent time‐period (2014–2019) (aHR 0.68[95% CI 0.54–0.86]), and where index (procto)colectomy was performed in low‐volume (<1 pouch/year) pouch hospitals (aHR 0.60 [95% CI 0.43–0.82]).ConclusionsNSW Australia has the highest reported rate of reconstruction following UC (procto)colectomy globally. However, rates reduced in the most recent time‐period. There was variation in reconstruction rates across centres, with primary and overall reconstruction rates proportionate to hospital pouch volume. Reconstruction rates were also lower for patients living outside major cities. To ensure equitable opportunities for reconstruction, patients being considered for IBD pouch surgery should be centralized to a limited number of specialist pouch centres.

Publisher

Wiley

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ans.18986

Reference32 articles.

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