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Published in:

01-07-2006

Increased Experience and Surgical Technique Lead to Improved Outcome After Ileal Pouch-Anal Anastomosis: A Population-Based Study

Authors: E. D. Kennedy, M.D., D. M. Rothwell, M.Sc., Z. Cohen, M.D., R. S. McLeod, M.D.

Published in: Diseases of the Colon & Rectum | Issue 7/2006

Purpose

This study was designed to determine whether changes in length of stay and 30-day readmission, reoperation, and excision rates for the ileal pouch-anal anastomosis occurred over time and with changes in surgical technique and hospital volume.

Methods

Using three population-based administrative databases, data on all ileal pouch-anal anastomoses performed in the province of Ontario between January 1992 and June 1998 were obtained. The effect of age, gender, stage of the procedure, year of surgery, and hospital volume were examined for their effect on length of stay and readmission, reoperation, and excision rates.

Results

There were 1,285 ileal pouch-anal anastomoses performed in 58 hospitals. There was a significant decrease in length of stay and reoperation and excision rates but a concommitant increase in readmission rate during the study period. Patients younger than aged 40 years had a significantly lower length of stay and excision rate. Patients who had a two-stage procedure had a shorter length of stay, readmission, and reoperative rate compared with those having a three-stage procedure. Hospital volume was a significant predictor of need for reoperation and excision with both low-volume and medium-volume hospitals having significantly higher rates than high-volume hospitals.

Conclusions

Outcome after ileal pouch-anal anastomosis has improved. It is significantly better in patients younger than aged 40 years, having a two-stage procedure, and where surgery is performed at high-volume hospitals. It is likely that both modifications in surgical technique and surgical experience have led to improvements in clinical outcome after ileal pouch-anal anastomosis.

Parks, AG, Nicholls, RJ 1978Proctocolectomy without ileostomy for ulcerative colitisBMJ28588PubMedCrossRef

Utsonomiya, J, Iwama, T, Imajo, M, et al. 1980Total colectomy, mucosal proctectomy, and ileoanal anastomosisDis Colon Rectum23459466CrossRef

Cohen, Z, McLeod, RS, Stephen, W, Stern, HS, O’Connor, BI, Reznick, R 1992Continuing evolution of the pelvic pouch procedureAnn Surg216506512PubMedCrossRef

Ziv, Y, Fazio, VW, Church, JM, Lavery, IC, King, TM, Ambrosetti, P 1996Stapled ileal pouch anal anastomoses aresafer than handsewn anastomoses in patients withulcerative colitisAm J Surg171320323PubMedCrossRef

Heuschen, UA, Hinz, U, Allemeyer, EH, Lucas, M, Heuschen, G, Herfarth, C 2001One or two stage procedure for restorative proctocolectomy. Rationale for a surgical strategy in ulcerative colitisAnn Surg234788794PubMedCrossRef

Sugerman, HJ, Newsome, HH 1994Stapled ileoanal anastomosis without a temporary ileostomyAm J Surg1675865PubMedCrossRef

Williams, JI, Young, W, et al. 1996A summary of studies on the quality of health care administrative databases in CanadaGoel, VWilliams, JIAnderson, GM eds. Patterns of Health Care in Ontario. The ICES Practice Atlas2nd ed.National Printers Inc.Ottawa, Canada(Available at: www.ices.on.ca)

Hawker, GA, Coyte, PC, Wright, JG, Paul, JE, Bombardier, C 1997Accuracy of administrative data for assessing outcomes after knee replacement surgeryJ Clin Epidemiol50265273PubMedCrossRef

Statistics Canada. Available at: www.statcan.ca/Daily/English/050928/d050928a.htm.

10.

Bernstein, CN, Blanchard, JF, Rawsthorne, P, Wajda, A 1999The epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian province: a population-based studyAm J Epidemiol149916924PubMed

11.

Melville, DM, Ritchie, JK, Nicholls, RJ, Hawley, PR 1994Surgery for ulcerative colitis in the era of the pouch: the St. Mark’s Hospital experienceGut3510761080PubMed

12.

Birkmeyer, JD, Finlayson, SR, Tosteson, AN, Sharp, SM, Warshaw, AL, Fisher, ES 1999Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomySurgery125250256PubMed

13.

Porter, GA, Soskolne, CL, Yakimets, WW, Newman, SC 1998Surgeon-related factors and outcome in rectal cancerAnn Surg227157167PubMedCrossRef

14.

Simunovic, M, To, T, Theriault, M, Langer, B 1999Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care systemCan Med Assoc J160643648

15.

Hannan, EL, Radzyner, M, Rubin, D, Dougherty, J, Brennan, MF 2002The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy and lung lobectomy in patients with cancerSurgery131615PubMedCrossRef

Title: Increased Experience and Surgical Technique Lead to Improved Outcome After Ileal Pouch-Anal Anastomosis: A Population-Based Study
Authors: E. D. Kennedy, M.D.
D. M. Rothwell, M.Sc.
Z. Cohen, M.D.
R. S. McLeod, M.D.
Publication date: 01-07-2006
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 7/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-006-0521-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Increased Experience and Surgical Technique Lead to Improved Outcome After Ileal Pouch-Anal Anastomosis: A Population-Based Study

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Purpose

Methods

Results

Conclusions

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