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International Journal of Colorectal Disease

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01-05-2018 | Original Article

Impact of sex on 30-day complications and long-term functional outcomes following ileal pouch-anal anastomosis for chronic ulcerative colitis

Authors: Nicholas P. McKenna, Eric J. Dozois, John H. Pemberton, Amy L. Lightner

Published in: International Journal of Colorectal Disease | Issue 5/2018

Abstract

Purpose

To determine the impact of patient sex on operative characteristics, short-term complications, and long-term functional outcomes following ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC).

Methods

A retrospective review was performed on all patients undergoing two- or three-stage IPAA for CUC at our institution between January 2002 and August 2013. Patient demographics, operative characteristics, 30-day postoperative complications, and long-term functional outcomes from annual survey data were analyzed comparing men and women patients.

Results

During the study period, 911 IPAAs (542 men, 369 women) were performed. Men were older and were more often obese (both p < 0.01). Use of a three-stage approach and laparoscopic approach were similar between men and women, but operation length, intraoperative blood loss, and hospital length of stay were all higher in men (all p < 0.05). At 30 days, women had increased rates of superficial surgical site infections and urinary tract infections (both p < 0.05), while men had increased rates of urinary retention (p = 0.03). Five hundred forty-six patients (60%; 307 men, 239 women) responded to the annual post IPAA survey with a median follow-up of 5.1 and 5.0 years in men and women, respectively. Women reported increased frequency of daytime stools in the early follow-up period, but this difference resolved with time. Other functional outcomes were similar.

Conclusion

Patient sex impacts intraoperative complexity, postoperative length of stay, 30-day postoperative outcomes, and initial long-term function. These findings underscore the need to adjust preoperative counseling regarding IPAA outcomes based on sex.

Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88CrossRefPubMedPubMedCentral

Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685. https://doi.org/10.1097/SLA.0b013e31827d99a2 CrossRefPubMed

Lightner AL, Mathis KL, Dozois EJ, Hahnsloser D, Loftus EV Jr, Raffals LE, Pemberton JH (2017) Results at up to 30 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis 23(5):781–790. https://doi.org/10.1097/MIB.0000000000001061 CrossRefPubMed

Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D (2000) Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 231(6):919–926CrossRefPubMedPubMedCentral

Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238(2):221–228. https://doi.org/10.1097/01.sla.0000080825.95166.26 PubMedPubMedCentral

Ramage L, Qiu S, Georgiou P, Tekkis P, Tan E (2016) Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review. Int J Color Dis 31(3):481–492. https://doi.org/10.1007/s00384-015-2475-4 CrossRef

Klos CL, Safar B, Jamal N, Hunt SR, Wise PE, Birnbaum EH, Fleshman JW, Mutch MG, Dharmarajan S (2014) Obesity increases risk for pouch-related complications following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). J Gastrointest Surg 18(3):573–579. https://doi.org/10.1007/s11605-013-2353-8 CrossRefPubMed

Khasawneh MA, McKenna NP, Abdelsattar ZM, Johnson A, Dozois EJ, Pemberton JH, Mathis KL (2016) Impact of BMI on ability to successfully create an IPAA. Dis Colon rectum 59(11):1034–1038. https://doi.org/10.1097/DCR.0000000000000686

Melton GB, Fazio VW, Kiran RP, He J, Lavery IC, Shen B, Achkar JP, Church JM, Remzi FH (2008) Long-term outcomes with ileal pouch-anal anastomosis and Crohn’s disease: pouch retention and implications of delayed diagnosis. Ann Surg 248(4):608–616. https://doi.org/10.1097/SLA.0b013e318187ed64 PubMed

10.

Hartley JE, Fazio VW, Remzi FH, Lavery IC, Church JM, Strong SA, Hull TL, Senagore AJ, Delaney CP (2004) Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon rectum 47(11):1808–1815

11.

Braveman JM, Schoetz DJ Jr, Marcello PW, Roberts PL, Coller JA, Murray JJ, Rusin LC (2004) The fate of the ileal pouch in patients developing Crohn’s disease. Dis Colon rectum 47(10):1613–1619

12.

Soravia C, Klein L, Berk T, O'Connor BI, Cohen Z, McLeod RS (1999) Comparison of ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis. Dis Colon rectum 42(8):1028–1033 discussion 1033-1024

13.

Soravia C, O'Connor BI, Berk T, McLeod RS, Cohen Z (1999) Functional outcome of conversion of ileorectal anastomosis to ileal pouch-anal anastomosis in patients with familial adenomatous polyposis and ulcerative colitis. Dis Colon rectum 42(7):903–908

14.

Ko CY, Rusin LC, Schoetz DJ Jr, Moreau L, Coller JA, Murray JJ, Roberts PL, Arnell TD (2000) Does better functional result equate with better quality of life? Implications for surgical treatment in familial adenomatous polyposis. Dis Colon rectum 43(6):829–835 discussion 835-827

15.

Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP (2012) Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon rectum 55(4):387–392. https://doi.org/10.1097/DCR.0b013e318246418e

16.

Chessin DB, Gorfine SR, Bub DS, Royston A, Wong D, Bauer JJ (2008) Septic complications after restorative proctocolectomy do not impair functional outcome: long-term follow-up from a specialty center. Dis Colon rectum 51(9):1312–1317. https://doi.org/10.1007/s10350-008-9413-2

17.

Gupta N, Bostrom AG, Kirschner BS, Ferry GD, Winter HS, Baldassano RN, Gold BD, Abramson O, Smith T, Cohen SA, Heyman MB (2007) Sex differences in presentation and course of disease in pediatric patients with Crohn disease. Pediatrics 120(6):e1418–e1425. https://doi.org/10.1542/peds.2007-0905 CrossRefPubMed

18.

Wagtmans MJ, Verspaget HW, Lamers CB, van Hogezand RA (2001) Sex-related differences in the clinical course of Crohn’s disease. Am J Gastroenterol 96(5):1541–1546. https://doi.org/10.1111/j.1572-0241.2001.03755.x CrossRefPubMed

19.

Betteridge JD, Armbruster SP, Maydonovitch C, Veerappan GR (2013) Inflammatory bowel disease prevalence by age, sex, race, and geographic location in the U.S. military health care population. Inflamm Bowel Dis 19(7):1421–1427. https://doi.org/10.1097/MIB.0b013e318281334d CrossRefPubMed

20.

Rottoli M, Remzi FH, Shen B, Kiran RP (2012) Sex of the patient may influence perioperative and long-term complications after restorative proctocolectomy. Color Dis 14(3):336–341. https://doi.org/10.1111/j.1463-1318.2011.02634.x CrossRef

21.

Wu XR, Ashburn J, Remzi FH, Li Y, Fass H, Shen B (2016) Male sex is associated with a high risk for chronic antibiotic-refractory pouchitis and ileal pouch anastomotic sinus. J Gastrointest Surg 20(3):631–639. https://doi.org/10.1007/s11605-015-2976-z CrossRefPubMed

22.

Kani HT, Shen B (2015) Male issues of the ileal pouch. Inflamm Bowel Dis 21(3):716–722. https://doi.org/10.1097/MIB.0000000000000226 CrossRefPubMed

23.

Lightner AL, Mathis KL, Dozois EJ, Hahnsloser D, Loftus EV Jr, Raffals LE, Pemberton JH (2017) Results at up to 30 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis 23:781–790. https://doi.org/10.1097/MIB.0000000000001061 CrossRefPubMed

24.

Gold EB (2011) The timing of the age at which natural menopause occurs. Obstet Gynecol Clin N Am 38(3):425–440. https://doi.org/10.1016/j.ogc.2011.05.002 CrossRef

25.

Larson DW, Lovely JK, Cima RR, Dozois EJ, Chua H, Wolff BG, Pemberton JH, Devine RR, Huebner M (2014) Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. Br J Surg 101(8):1023–1030. https://doi.org/10.1002/bjs.9534 CrossRefPubMed

26.

Erkek AB, Church JM, Remzi FH (2007) Age-related analysis of functional outcome and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis. J Gastroenterol Hepatol 22(5):710–714. https://doi.org/10.1111/j.1440-1746.2007.04870.x CrossRefPubMed

27.

Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, Michelassi F, Charlson ME, Milsom JW (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257(1):108–113. https://doi.org/10.1097/SLA.0b013e318262a6cd CrossRefPubMed

28.

McKenna NP, Mathis KL, Khasawneh MA, Dozois EJ, Larson DW, Pemberton JH, Lightner AL (2017) Obese patients undergoing Ileal pouch-anal anastomosis: short-and long-term surgical outcomes. Inflamm Bowel Dis 23(12):2142–2146. https://doi.org/10.1097/MIB.0000000000001238 CrossRefPubMed

29.

Canedo JA, Pinto RA, McLemore EC, Rosen L, Wexner SD (2010) Restorative proctectomy with ileal pouch-anal anastomosis in obese patients. Dis Colon rectum 53(7):1030–1034. https://doi.org/10.1007/DCR.0b013e3181db7029

30.

Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon rectum 43(5):604–608

31.

Chapuis PH, Bokey L, Keshava A, Rickard MJ, Stewart P, Young CJ, Dent OF (2013) Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg 257(5):909–915. https://doi.org/10.1097/SLA.0b013e318268a693 CrossRefPubMed

32.

Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E (2012) Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg 36(1):179–185. https://doi.org/10.1007/s00268-011-1339-5 CrossRefPubMed

33.

Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, Gernsheimer T, Holcomb JB, Kaplan LJ, Katz LM, Peterson N, Ramsey G, Rao SV, Roback JD, Shander A, Tobian AA (2016) Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 316(19):2025–2035. https://doi.org/10.1001/jama.2016.9185 CrossRefPubMed

34.

Rushton DH, Dover R, Sainsbury AW, Norris MJ, Gilkes JJ, Ramsay ID (2001) Why should women have lower reference limits for haemoglobin and ferritin concentrations than men? BMJ 322(7298):1355–1357CrossRefPubMedPubMedCentral

35.

Minardi D, d'Anzeo G, Cantoro D, Conti A, Muzzonigro G (2011) Urinary tract infections in women: etiology and treatment options. Int J Gen Med 4:333–343. https://doi.org/10.2147/IJGM.S11767 CrossRefPubMedPubMedCentral

36.

Langelotz C, Mueller-Rau C, Terziyski S, Rau B, Krannich A, Gastmeier P, Geffers C (2014) Sex-specific differences in surgical site infections: an analysis of 438,050 surgical procedures from the German National Nosocomial Infections Surveillance System. Viszeralmedizin 30(2):114–117. https://doi.org/10.1159/000362100 CrossRefPubMedPubMedCentral

37.

Cima RR, Bergquist JR, Hanson KT, Thiels CA, Habermann EB (2017) Outcomes are local: patient, disease, and procedure-specific risk factors for colorectal surgical site infections from a single institution. J Gastrointest Surg 21(7):1142–1152. https://doi.org/10.1007/s11605-017-3430-1 CrossRefPubMed

38.

Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS, Loftus EV Jr, Sandborn WJ, Wolff BG, Pemberton JH (2007) Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 204(5):956–962; discussion 962-953. https://doi.org/10.1016/j.jamcollsurg.2006.12.044 CrossRefPubMed

39.

Gorgun E, Ozben V, Stocchi L, Ozuner G, Liu X, Remzi F (2016) Impact of transfusion threshold on infectious complications after ileal pouch-anal anastomosis. J Gastrointest Surg 20(2):343–350. https://doi.org/10.1007/s11605-015-3054-2 CrossRefPubMed

40.

Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 238(3):433–441; discussion 442-435. https://doi.org/10.1097/01.sla.0000086658.60555.ea PubMedPubMedCentral

Title: Impact of sex on 30-day complications and long-term functional outcomes following ileal pouch-anal anastomosis for chronic ulcerative colitis
Authors: Nicholas P. McKenna
Eric J. Dozois
John H. Pemberton
Amy L. Lightner
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 5/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3020-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of sex on 30-day complications and long-term functional outcomes following ileal pouch-anal anastomosis for chronic ulcerative colitis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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