Trends in surgical outcomes for Ileal pouch–anal anastomosis construction using a large nationwide database

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2024-09-27 DOI:10.1111/codi.17188

Alyssa Habermann, Hannah Gassie, Salem Rustom, Nicole E. Wieghard, Steven D. Wexner, Stephen P. Sharp

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Abstract

Aim

Ulcerative colitis (UC) affects over 3 million (1.3%) US adults, approximately 20% of whom will require surgery. Since it was first described in 1978, restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become the gold standard for patients requiring surgery, as well as for patients with familial adenomatous polyposis (FAP). In 1991 the laparoscopic approach to IPAA was introduced. The aim of this study was to evaluate the advances made in IPAA as minimally invasive surgery (MIS) has become more prevalent.

Method

The American College of Surgeons NSQIP database from 2005 to 2019 was used. Laparoscopic (MIS) and open cases of IPAA construction for UC or FAP were used. These patients were subdivided into three time point cohorts: early (2005–2009), middle (2010–2014) and recent (2015–2019). Univariable and multivariable analyses were performed to evaluate morbidity, mortality and hospital length of stay.

Results

A total of 6184 patients were analysed, and 2555 underwent MIS while 3629 underwent open surgery. After multivariable analysis, the MIS approach was associated with a lower risk of morbidity compared with open procedures [relative risk (RR) = 0.86, p < 0.0001, 95% CI 0.78–0.94], both in the early and recent periods [early period = RR = 0.66 (p < 0.0001), recent period RR = 0.78 (p = 0.0029)]. Superficial surgical site infection (SSI) was consistently lower in the MIS cohort across all three time periods. After multivariable analysis, the overall RR of superficial SSI in the MIS cohort was 0.41 (p < 0.0001) [early period RR = 0.35 (p < 0.0001), middle period RR = 0.55 (p = 0.0007), recent period RR = 0.31 (p < 0.0001)]. The RR of deep space SSI was decreased overall (RR = 0.58, p = 0.013, 95% CI 0.62–0.93), with the most significant effect occurring during the early period (RR = 0.30, p = 0.0260, 95% CI 0.105–0.868). Sepsis related to any infective aetiology was also decreased in the MIS cohort (RR = 0.76, p = 0.0093, 95% CI 0.62–0.93), especially in the recent time period (RR = 0.63, p = 0.0344, 95% CI 0.41–0.97). Furthermore, hospital length of stay was decreased in the MIS cohort (−0.287 days, p = 0.0170), with a greater difference occurring in the more recent cohort (−0.375 days, p = 0.0418).

Conclusion

With increasing utilization of minimally invasive techniques in IPAA creation there have been significant decreases in the rates of morbidity including decreasing rates of superficial and deep space SSI, as well as decreased hospital length of stay.

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利用全国性大型数据库分析回肠袋-肛门吻合术的手术效果趋势。

目的：溃疡性结肠炎（UC）影响着 300 多万（1.3%）美国成年人，其中约 20% 需要手术治疗。自 1978 年首次描述以来，带回肠袋-肛门吻合术（IPAA）的恢复性直肠结肠切除术已成为需要手术的患者以及家族性腺瘤性息肉病（FAP）患者的金标准。1991 年，IPAA 引入了腹腔镜方法。本研究旨在评估随着微创手术（MIS）的普及，IPAA所取得的进展：方法：使用美国外科学院 2005 年至 2019 年 NSQIP 数据库。采用腹腔镜（MIS）和开腹病例对 UC 或 FAP 进行 IPAA 手术。这些患者被细分为三个时间点队列：早期（2005-2009 年）、中期（2010-2014 年）和近期（2015-2019 年）。对发病率、死亡率和住院时间进行单变量和多变量分析：共分析了 6184 名患者，其中 2555 人接受了 MIS 手术，3629 人接受了开放手术。经过多变量分析，与开放手术相比，微创手术的发病风险更低[相对风险（RR）= 0.86，P 结论：微创手术的发病率与开放手术的发病率呈正相关：随着微创技术在IPAA手术中的应用越来越多，发病率显著下降，包括浅表和深部间隙SSI发病率下降，住院时间缩短。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.

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