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.
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.
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.
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.
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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
Mark Kusek Colorectal Cancer Research Fellowship 2016–2018
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Part of this research was presented as a Podium Presentation at the meeting of the American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.
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Hoang, C.M., Maykel, J.A., Davids, J.S. et al. Distribution of Elective Ileal Pouch-Anal Anastomosis Cases for Ulcerative Colitis: a Study Utilizing the University Health System Consortium Database . J Gastrointest Surg 24, 2613–2619 (2020). https://doi.org/10.1007/s11605-019-04443-2
- Ulcerative colitis
- Ileal pouch-anal anastomosis