A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease

Saloomeh Sahami, Sanne A.L. Bartels, André D'Hoore, Tonia Young Fadok, Pieter J. Tanis, Robert Lindeboom, Anthony de Buck van Overstraeten, Albert M. Wolthuis, Willem A. Bemelman, Christianne J. Buskens

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Abstract

Background: Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. Results: A total of 640 patients [56.9% male] were included, with a median age of 38 years [interquartile range 29-48]; 96 [15.0%] patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index [BMI] > 25], (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.15-3.18), and American Society of Anesthesiologists classification [ASA score > 2] [OR 1.91; 95% CI 1.03-3.54] were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years [OR 2.34; 95% CI 1.42-3.87] and concurrent combination of anti-tumour necrosis factor [TNF] and steroids [OR 6.40; 95% CI 1.76-23.20] were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.

Original languageEnglish (US)
Pages (from-to)773-778
Number of pages6
JournalJournal of Crohn's and Colitis
Volume10
Issue number7
DOIs
StatePublished - 2016

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Restorative Proctocolectomy
Colonic Pouches
Anastomotic Leak
Inflammatory Bowel Diseases
Odds Ratio
Confidence Intervals
Body Mass Index
Tumor Necrosis Factor-alpha
Steroids
Tertiary Care Centers
Decision Making
Regression Analysis
Demography
Databases

Keywords

  • Anastomotic leakage
  • Ileal pouch-anal anastomosis
  • Risk factors

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease. / Sahami, Saloomeh; Bartels, Sanne A.L.; D'Hoore, André; Fadok, Tonia Young; Tanis, Pieter J.; Lindeboom, Robert; van Overstraeten, Anthony de Buck; Wolthuis, Albert M.; Bemelman, Willem A.; Buskens, Christianne J.

In: Journal of Crohn's and Colitis, Vol. 10, No. 7, 2016, p. 773-778.

Research output: Contribution to journalArticle

Sahami, S, Bartels, SAL, D'Hoore, A, Fadok, TY, Tanis, PJ, Lindeboom, R, van Overstraeten, ADB, Wolthuis, AM, Bemelman, WA & Buskens, CJ 2016, 'A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease', Journal of Crohn's and Colitis, vol. 10, no. 7, pp. 773-778. https://doi.org/10.1093/ecco-jcc/jjv170
Sahami, Saloomeh ; Bartels, Sanne A.L. ; D'Hoore, André ; Fadok, Tonia Young ; Tanis, Pieter J. ; Lindeboom, Robert ; van Overstraeten, Anthony de Buck ; Wolthuis, Albert M. ; Bemelman, Willem A. ; Buskens, Christianne J. / A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease. In: Journal of Crohn's and Colitis. 2016 ; Vol. 10, No. 7. pp. 773-778.
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abstract = "Background: Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. Results: A total of 640 patients [56.9{\%} male] were included, with a median age of 38 years [interquartile range 29-48]; 96 [15.0{\%}] patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index [BMI] > 25], (odds ratio [OR] 1.92; 95{\%} confidence interval [CI] 1.15-3.18), and American Society of Anesthesiologists classification [ASA score > 2] [OR 1.91; 95{\%} CI 1.03-3.54] were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years [OR 2.34; 95{\%} CI 1.42-3.87] and concurrent combination of anti-tumour necrosis factor [TNF] and steroids [OR 6.40; 95{\%} CI 1.76-23.20] were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.",
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author = "Saloomeh Sahami and Bartels, {Sanne A.L.} and Andr{\'e} D'Hoore and Fadok, {Tonia Young} and Tanis, {Pieter J.} and Robert Lindeboom and {van Overstraeten}, {Anthony de Buck} and Wolthuis, {Albert M.} and Bemelman, {Willem A.} and Buskens, {Christianne J.}",
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T1 - A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease

AU - Sahami, Saloomeh

AU - Bartels, Sanne A.L.

AU - D'Hoore, André

AU - Fadok, Tonia Young

AU - Tanis, Pieter J.

AU - Lindeboom, Robert

AU - van Overstraeten, Anthony de Buck

AU - Wolthuis, Albert M.

AU - Bemelman, Willem A.

AU - Buskens, Christianne J.

PY - 2016

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N2 - Background: Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. Results: A total of 640 patients [56.9% male] were included, with a median age of 38 years [interquartile range 29-48]; 96 [15.0%] patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index [BMI] > 25], (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.15-3.18), and American Society of Anesthesiologists classification [ASA score > 2] [OR 1.91; 95% CI 1.03-3.54] were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years [OR 2.34; 95% CI 1.42-3.87] and concurrent combination of anti-tumour necrosis factor [TNF] and steroids [OR 6.40; 95% CI 1.76-23.20] were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.

AB - Background: Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. Results: A total of 640 patients [56.9% male] were included, with a median age of 38 years [interquartile range 29-48]; 96 [15.0%] patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index [BMI] > 25], (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.15-3.18), and American Society of Anesthesiologists classification [ASA score > 2] [OR 1.91; 95% CI 1.03-3.54] were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years [OR 2.34; 95% CI 1.42-3.87] and concurrent combination of anti-tumour necrosis factor [TNF] and steroids [OR 6.40; 95% CI 1.76-23.20] were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.

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