Objective: Longterm functional outcomes after IPAA in female patients over 50 years have not been reported. Surgeons may thus hesitate to offer IPAA to these patients. We evaluate outcomes after IPAA in this group of patients. Methods: Between 1983 and 2007, data of all female patients >50 years old undergoing IPAA (Group A) were evaluated from a prospectively maintained institutional review board approved pelvic pouch database and patients’ records. Data included demographics, operative details, complications, functional outcomes and QOL. Functional outcomes were determined by bowel function, FIQL and FISI. The QOL was assessed using the Cleveland Global Quality of Life scale. Group A patients were compared with women younger than 50 years of age after matching for BMI, primary indication, year of surgery and final pathology (Group B). Results: Of 3382 patients with IPAA, 239 female patients > 50 years old in Group A. The mean age was 57.7±5.7 years and median follow-up 5 years (Iqr 2.2-10.1). Final pathological diagnosis was ulcerative colitis (66%), indeterminate colitis (15%), Crohn’s disease (5%), familial adenomatous polyposis (4%), and others (10%). Majority of patients had total proctocolectomy (68%), J-pouch (94%), stapled anastomosis (89.4%), and proximal diversion (88.7%). The two groups were comparable for the matched characteristics. Follow up duration (p=0.9), postoperative complications (p=0.95) and parity (p=0.6) were similar while comorbidities (p=0.004) and previous use of medications (p=0.02) were higher in Group A. Group A patients had worse function as manifest by incontinence (p >0.05), urgency (p=0.04), and pad usage (p=0.001). QOL was however similar (p=0.3). Conclusion: Although longterm pouch function in female patients over 50 years age is worse than their younger counterparts, QOL is comparable. This maybe related to the effect of age and should be considered when counseling before IPAA.

Variable		Group A (>50 yrs) (n=239)	Group B (<50 yrs) (n=239)	P-value
Bowel Movements	Day	6 (Iqr 4, 8)	5 (Iqr 4, 7)	0.4
	Night	2 (Iqr 1,3)	2 (Iqr 1, 3)	0.3
Pad Usage (No)	Day	92/189 (48.7%)	47/192 (24.5%)	0.001
	Night	109/190 (57.4%)	58/190 (30.5%)	0.001
Seepage (No)	Day	67/184 (36.4%)	50/183 (27.3%)	0.08
	Night	100/185 (54.1%)	72/190 (37.9%)	0.002
Urgency	never/rarely	106/201 (52.7%)	122/193 (63.2%)	0.04
Incontinence	never/rarely	129/198 (65.2%)	144/193 (74.6%)	0.05
FIQL-total		12.9±3.6	12.4±4.4	0.3
FISI		26.9±15.2	19.4±16.7	0.001
Cleveland Global Quality of Life Scale		0.8±0.2	0.8±0.2	0.25

FIQL=Fecal incontinence quality of lifeFISI=Fecal incontinence severity index