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Distribution of Elective Ileal Pouch-Anal Anastomosis Cases for Ulcerative Colitis: a Study Utilizing the University Health System Consortium Database

  • Chau M. HoangEmail author
  • Justin A. Maykel
  • Jennifer S. Davids
  • Allison S. Crawford
  • Paul R. Sturrock
  • Karim Alavi
Original Article
  • 31 Downloads

Abstract

Background

Trends and distribution of ileal pouch-anal anastomosis (IPAA) procedures for patients with ulcerative colitis (UC) are unknown. We examined the frequency, distribution, and volume-outcome relationship for this relatively infrequent procedure using a large national data source.

Methods

Data were obtained from the University HealthSystem Consortium (UHC) for patients with a primary diagnosis of UC admitted electively and who underwent surgical intervention between 2012 and 2015.

Results

The mean age of the study population (n = 6875) was 43 years and 57% were men. Among these, one-third (n = 2307) underwent an IPAA, while 24% (n = 1160) underwent total abdominal colectomy, 16% (n = 1134) underwent proctectomy, and 2% (n = 108) underwent total proctocolectomy with end ileostomy. The frequency of IPAA cases among all elective surgical cases was relatively stable at 33–35% over the study period. A total of 131 hospitals, out of 279 hospitals participating in the UHC (47%), performed IPAA. UHC contains all inpatient data on more than 140 (> 90%) academic medical centers in the US and their affiliates. Most hospitals (101) performed < 5 cases annually. The median number of IPAA cases performed annually was 1.8 [IQR 0.8 – 4.3]. The top 10 hospitals performed one-half (48%) of IPAA cases, but only 18% of another type of complex pelvic dissection cases such as low anterior resection. Short-term postoperative complications after IPAA, however, were similar regardless of IPAA volume.

Conclusions

Nearly one-half of IPAA cases were performed at only 10 hospitals out of the 131 hospitals performing IPAA in the study. IPAA procedures are infrequently performed by most academic medical centers in the US. The redistribution of IPAA procedures, likely a result of previously established referral patterns and centralization, has a potential impact on the training of future colorectal fellows as well as access to care.

Keywords

Pouch IPAA Ulcerative colitis Ileal pouch-anal anastomosis 

Notes

Acknowledgments

Mark Kusek Colorectal Cancer Research Fellowship for funding

Robert J. Goldberg, PhD, for critical revisions of early drafts of the manuscript

Contributions of Authors

Hoang: design of study, analysis and interpretation of data, drafting and revising manuscript, final approval, agreement to be accountable

Maykel: design of study, interpretation of data, revision of manuscript, final approval, agreement to be accountable

Davids: design of study, interpretation of data, revision of manuscript, final approval, agreement to be accountable

Wyman Crawford: acquisition of data, revision of manuscript, final approval, agreement to be accountable

Sturrock: design of study, revision of manuscript, final approval, agreement to be accountable

Alavi: conception and design of study, interpretation of data, drafting and revising manuscript, final approval, agreement to be accountable

Categories: inflammatory bowel disease

Funding Information

Mark Kusek Colorectal Cancer Research Fellowship 2016–2018

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Mark Kusek Colorectal Cancer Research Fellowship 2016–2018, Division of Colon and Rectal SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Division of Colon and Rectal SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.General Surgery ResidencyUniversity of Massachusetts Medical SchoolWorcesterUSA
  4. 4.Center for Outcomes Research, Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA

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