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Does Gender Affect Short-Term Outcomes After Laparoscopic Total Proctocolectomy With IPAA for Ulcerative Colitis?
Ozgen Isik*, Emre Gorgun, Meagan Costedio, Hermann P. Kessler, Feza H. Remzi
Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
Introduction: Total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is the surgical procedure of choice for the treatment of mucosal ulcerative colitis. Whether the gender of the patient influences short-term outcomes after laparoscopic TPC with IPAA has not been assessed. Anatomic and physiologic differences between genders affect both the operation and possibly postoperative outcomes. In this study, we aim to determine the impact of gender on short-term outcomes after laparoscopic TPC with IPAA from a nationwide database.
Methods: All patients who underwent laparoscopic TPC with IPAA for ulcerative colitis between 2005 and 2010 were identified from the ACS-NSQIP database based on their CPT and ICD-9 codes. Patients younger than 18 and older than 80 years old were excluded. Thirty day outcomes were evaluated and a stepwise logistic regression analysis was performed, in order to determine risk factors for each gender.
Results: In total, 253 female and 301 male patients were included in the study. While mean BMI was higher for male patients, the number of obese patients and mean age was comparable between the groups (table). Male gender was associated with a significantly longer operative time (303.2 +/- 93.9 vs. 318.7 +/- 103.7, p= 0.04). Urinary infection rate was higher for female patients (9.5 % vs. 0.7 %, p= 0.001). Superficial, deep, and organ space surgical site infections (SSI), pneumonia, sepsis, septic shock and mortality rates were similar for both genders.
Conclusion: Laparoscopic total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis has comparable short-term outcomes in both genders. Despite deep and narrow male pelvis, achieving similar short term outcomes with the exception of prolonged operating time may be due to superior visualization with laparoscopy. Table: Summary of patient demographics and outcomes | Female n= 253 (45.7%) | Male n= 301 (54.3%) | P-value | | Age, (year) | 38.8 +/- 13 | 40.2 +/- 13.9 | 0.23 | | Body Mass Index (BMI), (kg/m2) | 24.7 +/- 5.5 | 25.9 +/- 5.1 | <0.001 | | Obesity (BMI> 30 kg/m2) | 16% | 17.9% | 0.55 | | Steroid use * | 51.8% | 52.5% | 0.87 | | ASA Class | | | >0.99 | | I | 4.3% | 4.3% | | | II | 79.1% | 79.1% | | | III | 16.6% | 16.6% | | | Emergency surgery | 0 | 1% | 0.25 | | Superficial SSI ** | 4.7% | 5% | 0.9 | | Deep SSI | 1.6% | 0.3% | 0.18 | | Organ space SSI | 7.5% | 10.3% | 0.26 | | Pneumonia | 0.8% | 1.7% | 0.46 | | Sepsis | 7.5% | 7% | 0.81 | | Septic shock | 1.2% | 1.3% | >0.99 | | Mortality | 0 | 1.3% | 0.13 |
* Regular administration of oral or parenteral corticosteroid medications in the 30 days prior to the surgery ** Surgical site infection
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