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RESETTING THE CLOCK: DOES REDO IPAA RESTORE QUALITY OF LIFE? PATIENT REPORTED OUTCOMES BEFORE AND AFTER REDO ILEOANAL POUCH SURGERY
Stefan D. Holubar
*, Olga Lavryk, Jeremy M. Lipman, Arielle E. Kanters, Benjamin L. Cohen, Katherine Falloon, Florian Rieder, Taha Qazi, Emre Gorgun, Scott Steele, David Liska
Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH
IntroductionPatient-reported outcomes (PROs) after ileoanal pouch (IPAA) salvage with redo pouch procedures are known to be worse compared to after primary (index) pouch surgery. Although pouch failure is associated with decreased pouch function and quality of life (QoL), PROs prior to redo IPAA have not been reported. We aimed to report on PRO before and after redo IPAA. We hypothesized that redo IPAA is associated with improved quality of life.
MethodsOur pouch registry was queried for adults who underwent redo IPAA between 1984 and 2024, who had at least one pouch survey before and after redo pouch surgery. Pouch surveys were mailed to all patients annually and also collected in clinic (paper survey), and several items were administered electronically from to 2015-2019 (electronic survey). Our primary outcome was the Cleveland Global QoL index (CGQLI), a composite of QoL, quality of health (QoH), and quality of energy (QoE), each of which was scored from 0 (lowest) to 10 (highest). These three scores were then summed and divided by 30 to obtain an overall score ranging from 0 (lowest) to 1 (highest). Before and after survey responses were compared using univariate analysis with t-tests and Wilcoxon rank-sum tests, and matched paired analysis, using JMP v18.1.
ResultsA total of 659 redo pouch procedures, including pouch excision with neo-IPAA in 387 (58%) and pouch repair with neo-IPAA in 272 (41%), were included, of which 472 (72%) had survey data available and were analyzed. Results from the paper survey (
Table 1) revealed bowel frequency, urgency, incontinence, seepage, pad usage, fiber, and anti-diarrheal usage were not significantly different after, compared with before, redo IPAA. After redo IPAA, 87% would undergo redo surgery again and 89% would recommend IPAA. Happiness with surgery was higher after redo IPAA (from 8 to 9, p=0.02 overall; p=0.08, pairwise). Matched pair analysis of the electronic survey responses (
Table 1) revealed after redo IPAA, dietary restrictions increased (from 51% to 54%, p=0.03), social restrictions decreased (from 44% to 34%, p=0.05), whereas work and sexual restrictions remained unchanged. After redo IPAA, QoL (from 7 to 8, p=0.0004), QoH (from 7 to 8, p=0.0003) and CGQLI (from 0.57 to 0.67, p=0.003) and were significantly higher after, compared with before, redo IPAA.
ConclusionsRedo IPAA, on matched pair analysis, was restorative for the decreased quality of life and social restrictions observed prior to redo pouch surgery, without sacrificing functional outcomes for most patients. This novel view of PROs after redo IPAA compared with before redo IPAA sheds new light on what may be reasonably be expected after redo IPAA for patients with failing pouches contemplating redo IPAA surgery.
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