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J Surg Res. 2019 Jul;239:216-223. doi: 10.1016/j.jss.2019.02.014. Epub 2019 Mar 7.

Surgery During Admission for an Ulcerative Colitis Flare: Should Pouch Formation Be Considered?

Author information

1
Department of Surgery, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. Electronic address: Mckenna.nicholas@mayo.edu.
2
Department of Health Sciences Research, Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
3
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.
4
Department of Surgery, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

Abstract

BACKGROUND:

Up to 25% of patients with ulcerative colitis will require hospitalization for a disease flare and 10% of these patients will require semiurgent colectomy during the same admission. Limited evidence exists to guide decision-making on the safety of ileal pouch anal anastomosis (IPAA) in the semiurgent setting.

MATERIALS AND METHODS:

The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2016 for patients with a diagnosis of ulcerative colitis undergoing semiurgent (hospitalization > 48 h before surgery) total proctocolectomy (TPC) with IPAA, semiurgent subtotal colectomy (STC), or elective TPC with IPAA. The association of semiurgent pouch formation with 30-d major morbidity and organ space infection was assessed against semiurgent STC and elective TPC with IPAA by univariate comparisons and multivariable logistic regression.

RESULTS:

A total of 3763 patients (semiurgent TPC with IPAA = 101, semiurgent STC = 797, elective TPC with IPAA = 2865) were included. Semiurgent TPC with IPAA was associated with a higher rate of major morbidity (28% versus 20%, P = 0.04) and organ space infection (19% versus 8%, P < 0.01) than elective TPC. On multivariable analysis, semiurgent status did not significantly increase the odds major morbidity (adjusted odds ratio, 1.2; 95% confidence interval [CI], 0.7-1.9), but it was a risk factor for organ space infection (2.3; 1.4-4.0). Major morbidity did not significantly differ between semiurgent TPC with IPAA and semiurgent STC (adjusted odds ratio: 1.5; 95% CI: 0.9-2.5).

CONCLUSIONS:

Semiurgent IPAA was associated with an increased risk of major morbidity and organ space infection. Subtotal colectomy should remain the preferred operation in the semiurgent setting.

KEYWORDS:

IPAA; NSQIP; Semiurgent surgery; Ulcerative colitis

PMID:
30852448
DOI:
10.1016/j.jss.2019.02.014

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