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

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.

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References

  1. 1.

    Dubinsky MC. Reviewing treatments and outcomes in the evolving landscape of ulcerative colitis. Postgrad Med. 2017;129(5):538-553.

    Article  Google Scholar 

  2. 2.

    Krane MK, Lange EO, Fichera A. Chapter 50: Ulcerative Colitis: Surgical Management. In: Steele SR, Hull T, Read T, Saclarides T, Senagore A, Whitlow C, eds. The ASCRS Textbook of Colon and Rectal Surgery . 3e ed. Arlington Heights: Springer; 2016.

    Google Scholar 

  3. 3.

    Fumery M, Singh S, Dulai PS, Gower-Rousseau C, Peyrin-Biroulet L, Sandborn WJ. Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review. Clin Gastroenterol Hepatol. 2017;16(3):343-356.

    Article  Google Scholar 

  4. 4.

    Bikhchandani J, Polites SF, Wagie AE, Habermann EB, Cima RR. National trends of 3-versus 2-stage restorative proctocolectomy for chronic ulcerative colitis. Dis Colon Rectum. 2015;58(2):199-204.

    Article  Google Scholar 

  5. 5.

    Derstine PL. Colon and Rectal Surgery Review Committee Update. APDCRS Annual Meeting [Presentation]. 2016; http://www.acgme.org/Portals/0/PFAssets/Presentations/Program_Director_2016_RRC_Update.pdf. Accessed July 28, 2017.

  6. 6.

    Damle RN, Cherng NB, Flahive JM, et al. Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs. Dis Colon Rectum. 2014;57(12):1421-1429.

    Article  Google Scholar 

  7. 7.

    Huo YR, Phan K, Morris DL, Liauw W. Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery. J Gastrointest Oncol. 2017;8(3):534-546.

    Article  Google Scholar 

  8. 8.

    Kothari AN, Blanco BA, Brownlee SA, et al. Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care. Surgery. 2016;160(4):839-849.

    Article  Google Scholar 

  9. 9.

    Stern JR, Sun T, Mao J, Sedrakyan A, Meltzer AJ. A Decade of Thoracic Endovascular Aortic Aneurysm Repair in New York State: Volumes, Outcomes, and Implications for the Dissemination of Endovascular Technology. Ann Vasc Surg. 2018.

  10. 10.

    Mark-Christensen A, Erichsen R, Brandsborg S, et al. Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis. Colorectal Dis. 2018;20(1):44-52.

    CAS  Article  Google Scholar 

  11. 11.

    Remzi FH, Lavryk OA, Ashburn JH, et al. Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care. Colorectal Dis. 2017;19(11):1003-1012.

    CAS  Article  Google Scholar 

  12. 12.

    Fazio VW, Tekkis PP, Remzi F, et al. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg. 2003;238(4):605-614;discussion 614-607.

    Google Scholar 

  13. 13.

    Helavirta I, Huhtala H, Hyoty M, Collin P, Aitola P. Restorative Proctocolectomy for Ulcerative Colitis in 1985-2009. Scand J Surg. 2016;105(2):73-77.

    CAS  Article  Google Scholar 

  14. 14.

    Sahami S, Bartels SA, D'Hoore A, et al. A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease. J Crohns Colitis. 2016;10(7):773-778.

    Article  Google Scholar 

  15. 15.

    Lightner AL, Mathis KL, Dozois EJ, et al. Results at Up to 30 Years After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis. Inflamm Bowel Dis. 2017;23(5):781-790.

    Article  Google Scholar 

  16. 16.

    Tonelli F, Giudici F, Di Martino C, Scaringi S, Ficari F, Addasi R. Outcome after ileal pouch-anal anastomosis in ulcerative colitis patients: experience during a 27-year period. ANZ J Surg. 2016;86(10):768-772.

    Article  Google Scholar 

  17. 17.

    Germain A, de Buck van Overstraeten A, Wolthuis A, et al. Outcome of restorative proctocolectomy with an ileo-anal pouch for ulcerative colitis: effect of changes in clinical practice. Colorectal Dis. 2018;20(2):O30-o38.

    CAS  Article  Google Scholar 

  18. 18.

    Gorgun E, Remzi FH. Complications of Ileoanal Pouches. Clin Colon Rectal Surg. 2004;17(1):43-55.

    Article  Google Scholar 

  19. 19.

    Fearnhead NS, Lee MJ, Acheson AG, Worley G, Faiz OD, Brown SR. Variation in practice of pouch surgery in England - using SWORD data to cut to the chase and justify centralization. Colorectal Dis. 2018;20(7):597-605.

    CAS  Article  Google Scholar 

  20. 20.

    SooHoo NF, Zingmond DS, Ko CY. Disparities in the Utilization of High-Volume Hospitals for Total Knee Replacement. J Natl Med Assoc. 2008;100(5):559-564.

    Article  Google Scholar 

  21. 21.

    Loehrer AP, Chang DC, Song Z, Chang GJ. Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations. J Oncol Pract. 2018;14(1):e42-e50.

    Article  Google Scholar 

  22. 22.

    Trinh QD, Sun M, Sammon J, et al. Disparities in access to care at high-volume institutions for uro-oncologic procedures. Cancer. 2012;118(18):4421-4426.

    Article  Google Scholar 

  23. 23.

    Livingston EH, Burchell I. Reduced access to care resulting from centers of excellence initiatives in bariatric surgery. Arch Surg. 2010;145(10):993-997.

    Article  Google Scholar 

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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

Mark Kusek Colorectal Cancer Research Fellowship 2016–2018

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Correspondence to Chau M. Hoang.

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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

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Keywords

  • Pouch
  • IPAA
  • Ulcerative colitis
  • Ileal pouch-anal anastomosis