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OUTCOMES OF ILEAL POUCH EXCISION: AN AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM ANALYSIS
Sebastien Lachance*, Maria Abou Khalil, Nancy Morin, Carol-Ann Vasilevsky, Gabriela Ghitulescu, Julio Faria, Philip H. Gordon, Marylise Boutros
Division of Colorectal Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
Background: Ileal pouch excision is a rare yet complex procedure. Outcomes associated with this procedure have only been described in small single-center retrospective series. This study aimed to assess outcomes of ileal pouch excision and determine predictors of 30-day morbidity in a large multi-center, validated database. Methods: After institutional review board approval, a retrospective analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program was conducted. Adult patients who underwent ileal pouch excision between 2005-2015 were identified using Current Procedural Terminology codes. This study aimed to describe rates of specific 30-day morbidities and mortality following ileal pouch excision. Risk factors pertaining to these outcomes were assessed with logistic regression models.
Results: From 2005-2015, 381 patients underwent ileal pouch excision. The mean age was 47.7 (±15.3) years and 51.7% were female. Patients had a mean body mass index of 24.6 (±5.7) kg/m2, 55.4% were American Society of Anesthesia class 1-2 and 18.4% were immunosuppressed. The mean operative room time was 252 minutes (±112.7), 98.0% of cases were elective, 2.0 % of cases were emergent, and the median length of stay was 7 days (5-11). All patients suffered at least one postoperative 30-day morbidity, which most notably included surgical site infection (21.5% overall, 9.2% superficial, 3.7% deep, 10.3% organ space), sepsis (9.5%), urinary tract infection (5.8%), and postoperative pneumonia (2.4%). Reoperation was required in 5.5% of cases. The postoperative mortality rate was 0.8%. On multivariate logistic regression, smoking (OR 3.20 [95%CI 1.66-6.20]) and operative time (OR 1.002 [95% CI 1.0002, 1.0048]) were associated with increased odds of all surgical site infections.
Conclusion: To our knowledge, this is the largest study describing outcomes and risk factors of morbidity for ileal pouch excision. This is an operation with significant potential morbidity. Specific 30-day morbidities were most significant for septic complications, encompassing surgical site infection, urinary tract infection, postoperative pneumonia, and sepsis. Patients who were smokers and had longer operative time had increased risk of infectious complications. These factors are important when counselling and preparing patients for ileal pouch excision.
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