PMID- 29697787
OWN - NLM
STAT- MEDLINE
DCOM- 20190717
LR  - 20200522
IS  - 1536-4844 (Electronic)
IS  - 1078-0998 (Print)
IS  - 1078-0998 (Linking)
VI  - 24
IP  - 8
DP  - 2018 Jul 12
TI  - Delayed Ileal Pouch Anal Anastomosis Has a Lower 30-Day Adverse Event Rate: 
      Analysis From the National Surgical Quality Improvement Program.
PG  - 1833-1839
LID - 10.1093/ibd/izy082 [doi]
AB  - BACKGROUND: Ulcerative colitis (UC) patients requiring colectomy often have a 
      staged ileal pouch anal anastomosis (IPAA). There are no prospective data 
      comparing timing of pouch creation. We aimed to compare 30-day adverse event 
      rates for pouch creation at the time of colectomy (PTC) with delayed pouch 
      creation (DPC). METHODS: Using prospectively collected data from 2011-2015 
      through the National Surgical Quality Improvement Program, we conducted a cohort 
      study including subjects aged >/=18 years with a postoperative diagnosis of UC. We 
      assessed 30-day postoperative rates of unplanned readmissions, reoperations, and 
      major and minor adverse events (AEs), comparing the stage of the surgery where 
      the pouch creation took place. Using a modified Poisson regression model, we 
      estimated risk ratios (RRs) with 95% confidence intervals (CIs) adjusting for 
      age, sex, race, body mass index, smoking status, diabetes, albumin, and 
      comorbidities. RESULTS: Of 2390 IPAA procedures, 1571 were PTC and 819 were DPC. 
      In the PTC group, 51% were on chronic immunosuppression preoperatively, compared 
      with 15% in the DPC group (P < 0.01). After controlling for confounders, patients 
      who had DPC were significantly less likely to have unplanned reoperations (RR, 
      0.42; 95% CI, 0.24-0.75), major AEs (RR, 0.72; 95% CI, 0.52-0.99), and minor AEs 
      (RR, 0.48; 95% CI, 0.32-0.73) than PTC. CONCLUSIONS: Patients undergoing delayed 
      pouch creation were at lower risk for unplanned reoperations and major and minor 
      adverse events compared with patients undergoing pouch creation at the time of 
      colectomy. 10.1093/ibd/izy082_video1izy082.video15776112442001.
FAU - Kochar, Bharati
AU  - Kochar B
AD  - Multidisciplinary Center for Inflammatory Bowel Disease, North Carolina.
AD  - Center for Gastrointestinal Biology and Disease, North Carolina.
FAU - Barnes, Edward L
AU  - Barnes EL
AD  - Multidisciplinary Center for Inflammatory Bowel Disease, North Carolina.
AD  - Center for Gastrointestinal Biology and Disease, North Carolina.
FAU - Peery, Anne F
AU  - Peery AF
AD  - Center for Gastrointestinal Biology and Disease, North Carolina.
FAU - Cools, Katherine S
AU  - Cools KS
AD  - Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
FAU - Galanko, Joseph
AU  - Galanko J
AD  - Center for Gastrointestinal Biology and Disease, North Carolina.
FAU - Koruda, Mark
AU  - Koruda M
AD  - Multidisciplinary Center for Inflammatory Bowel Disease, North Carolina.
AD  - Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
FAU - Herfarth, Hans H
AU  - Herfarth HH
AD  - Multidisciplinary Center for Inflammatory Bowel Disease, North Carolina.
AD  - Center for Gastrointestinal Biology and Disease, North Carolina.
LA  - eng
GR  - T32 DK007634/DK/NIDDK NIH HHS/United States
GR  - K23 DK113225/DK/NIDDK NIH HHS/United States
GR  - R25 CA116339/CA/NCI NIH HHS/United States
GR  - U01 DK092239/DK/NIDDK NIH HHS/United States
GR  - T32 CA116339/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Inflamm Bowel Dis
JT  - Inflammatory bowel diseases
JID - 9508162
SB  - IM
MH  - Adult
MH  - Anastomosis, Surgical
MH  - Cohort Studies
MH  - Colitis, Ulcerative/*surgery
MH  - Colonic Pouches/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Readmission/statistics & numerical data
MH  - Postoperative Complications/*epidemiology
MH  - Proctocolectomy, Restorative/*adverse effects
MH  - Quality Improvement
MH  - Regression Analysis
MH  - Reoperation/statistics & numerical data
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
PMC - PMC6703434
EDAT- 2018/04/27 06:00
MHDA- 2019/07/18 06:00
PMCR- 2019/08/01
CRDT- 2018/04/27 06:00
PHST- 2017/10/30 00:00 [received]
PHST- 2018/04/27 06:00 [pubmed]
PHST- 2019/07/18 06:00 [medline]
PHST- 2018/04/27 06:00 [entrez]
PHST- 2019/08/01 00:00 [pmc-release]
AID - 4985683 [pii]
AID - izy082 [pii]
AID - 10.1093/ibd/izy082 [doi]
PST - ppublish
SO  - Inflamm Bowel Dis. 2018 Jul 12;24(8):1833-1839. doi: 10.1093/ibd/izy082.