National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis

Jai Bikhchandani, Stephanie F. Polites, Amy E. Wagie, Elizabeth B Habermann, Robert R. Cima

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND: Patients undergoing surgical treatment of chronic ulcerative colitis usually undergo a staged approach to IPAA.

OBJECTIVE: The purpose of this work was to identify the national trends in approach to IPAA for chronic ulcerative colitis and to evaluate 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program.

DESIGN: This was a retrospective review study

SETTINGS: : This study was conducted at a tertiary care cancer center.

PATIENTS: Patients with chronic ulcerative colitis who underwent IPAA from 2005 to 2011 were identified. Those who underwent colectomy with pouch procedure were placed in a 2-stage cohort, and those without simultaneous colectomy were part of a 3-stage cohort. Emergent operations were excluded.

MAIN OUTCOME MEASURES: Trends in procedure mix, preoperative characteristics, and postoperative 30-day outcomes were compared. Multivariate analysis was used to identify independent risk factors for postoperative infection.

RESULTS: Of 2002 patients who underwent IPAA, 1452 (72.5%) underwent 2-stage and 550 (27.5%) underwent 3-stage surgery. Since 2007, the distribution of 2- versus 3-stage procedures has not changed (p = 0.66). At the time of pouch surgery, patients who had undergone 3-stage surgery were less likely to have preoperative corticosteroid therapy, albumin <3 mg/dL, preoperative sepsis, and weight loss (all p < 0.05). Superficial surgical site infection was more common after 3-stage surgery (11.5% vs 7.3%; p < 0.01). After controlling for preoperative factors, wound classification was the only independent predictor of deep incisional or organ space infection (p < 0.01; OR, 1.76; 95% CI, 1.23-2.53).

LIMITATIONS: This was a retrospective study.

CONCLUSIONS: National trends of 2- versus 3-stage IPAA have remained stable over the last 5 years. Patients who underwent a 3-stage approach were healthier at the time of pouch surgery, with decreased corticosteroid use, hypoalbuminemia, and weight loss. Mixed results were seen for infectious complications with either approach. Prospective research is needed to determine the best approach to IPAA for chronic ulcerative colitis.

Original languageEnglish (US)
Pages (from-to)199-204
Number of pages6
JournalDiseases of the Colon and Rectum
Volume58
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Restorative Proctocolectomy
Ulcerative Colitis
Colectomy
Weight Loss
Adrenal Cortex Hormones
Preoperative Care
Surgical Wound Infection
Hypoalbuminemia
Quality Improvement
Infection
Tertiary Care Centers
Albumins
Sepsis
Multivariate Analysis
Retrospective Studies
Wounds and Injuries
Therapeutics
Research
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis. / Bikhchandani, Jai; Polites, Stephanie F.; Wagie, Amy E.; Habermann, Elizabeth B; Cima, Robert R.

In: Diseases of the Colon and Rectum, Vol. 58, No. 2, 01.02.2015, p. 199-204.

Research output: Contribution to journalArticle

Bikhchandani, Jai ; Polites, Stephanie F. ; Wagie, Amy E. ; Habermann, Elizabeth B ; Cima, Robert R. / National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis. In: Diseases of the Colon and Rectum. 2015 ; Vol. 58, No. 2. pp. 199-204.
@article{4bbce5f84e2b4e10a0a7f93074b52317,
title = "National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis",
abstract = "BACKGROUND: Patients undergoing surgical treatment of chronic ulcerative colitis usually undergo a staged approach to IPAA.OBJECTIVE: The purpose of this work was to identify the national trends in approach to IPAA for chronic ulcerative colitis and to evaluate 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program.DESIGN: This was a retrospective review studySETTINGS: : This study was conducted at a tertiary care cancer center.PATIENTS: Patients with chronic ulcerative colitis who underwent IPAA from 2005 to 2011 were identified. Those who underwent colectomy with pouch procedure were placed in a 2-stage cohort, and those without simultaneous colectomy were part of a 3-stage cohort. Emergent operations were excluded.MAIN OUTCOME MEASURES: Trends in procedure mix, preoperative characteristics, and postoperative 30-day outcomes were compared. Multivariate analysis was used to identify independent risk factors for postoperative infection.RESULTS: Of 2002 patients who underwent IPAA, 1452 (72.5{\%}) underwent 2-stage and 550 (27.5{\%}) underwent 3-stage surgery. Since 2007, the distribution of 2- versus 3-stage procedures has not changed (p = 0.66). At the time of pouch surgery, patients who had undergone 3-stage surgery were less likely to have preoperative corticosteroid therapy, albumin <3 mg/dL, preoperative sepsis, and weight loss (all p < 0.05). Superficial surgical site infection was more common after 3-stage surgery (11.5{\%} vs 7.3{\%}; p < 0.01). After controlling for preoperative factors, wound classification was the only independent predictor of deep incisional or organ space infection (p < 0.01; OR, 1.76; 95{\%} CI, 1.23-2.53).LIMITATIONS: This was a retrospective study.CONCLUSIONS: National trends of 2- versus 3-stage IPAA have remained stable over the last 5 years. Patients who underwent a 3-stage approach were healthier at the time of pouch surgery, with decreased corticosteroid use, hypoalbuminemia, and weight loss. Mixed results were seen for infectious complications with either approach. Prospective research is needed to determine the best approach to IPAA for chronic ulcerative colitis.",
author = "Jai Bikhchandani and Polites, {Stephanie F.} and Wagie, {Amy E.} and Habermann, {Elizabeth B} and Cima, {Robert R.}",
year = "2015",
month = "2",
day = "1",
doi = "10.1097/DCR.0000000000000282",
language = "English (US)",
volume = "58",
pages = "199--204",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis

AU - Bikhchandani, Jai

AU - Polites, Stephanie F.

AU - Wagie, Amy E.

AU - Habermann, Elizabeth B

AU - Cima, Robert R.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: Patients undergoing surgical treatment of chronic ulcerative colitis usually undergo a staged approach to IPAA.OBJECTIVE: The purpose of this work was to identify the national trends in approach to IPAA for chronic ulcerative colitis and to evaluate 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program.DESIGN: This was a retrospective review studySETTINGS: : This study was conducted at a tertiary care cancer center.PATIENTS: Patients with chronic ulcerative colitis who underwent IPAA from 2005 to 2011 were identified. Those who underwent colectomy with pouch procedure were placed in a 2-stage cohort, and those without simultaneous colectomy were part of a 3-stage cohort. Emergent operations were excluded.MAIN OUTCOME MEASURES: Trends in procedure mix, preoperative characteristics, and postoperative 30-day outcomes were compared. Multivariate analysis was used to identify independent risk factors for postoperative infection.RESULTS: Of 2002 patients who underwent IPAA, 1452 (72.5%) underwent 2-stage and 550 (27.5%) underwent 3-stage surgery. Since 2007, the distribution of 2- versus 3-stage procedures has not changed (p = 0.66). At the time of pouch surgery, patients who had undergone 3-stage surgery were less likely to have preoperative corticosteroid therapy, albumin <3 mg/dL, preoperative sepsis, and weight loss (all p < 0.05). Superficial surgical site infection was more common after 3-stage surgery (11.5% vs 7.3%; p < 0.01). After controlling for preoperative factors, wound classification was the only independent predictor of deep incisional or organ space infection (p < 0.01; OR, 1.76; 95% CI, 1.23-2.53).LIMITATIONS: This was a retrospective study.CONCLUSIONS: National trends of 2- versus 3-stage IPAA have remained stable over the last 5 years. Patients who underwent a 3-stage approach were healthier at the time of pouch surgery, with decreased corticosteroid use, hypoalbuminemia, and weight loss. Mixed results were seen for infectious complications with either approach. Prospective research is needed to determine the best approach to IPAA for chronic ulcerative colitis.

AB - BACKGROUND: Patients undergoing surgical treatment of chronic ulcerative colitis usually undergo a staged approach to IPAA.OBJECTIVE: The purpose of this work was to identify the national trends in approach to IPAA for chronic ulcerative colitis and to evaluate 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program.DESIGN: This was a retrospective review studySETTINGS: : This study was conducted at a tertiary care cancer center.PATIENTS: Patients with chronic ulcerative colitis who underwent IPAA from 2005 to 2011 were identified. Those who underwent colectomy with pouch procedure were placed in a 2-stage cohort, and those without simultaneous colectomy were part of a 3-stage cohort. Emergent operations were excluded.MAIN OUTCOME MEASURES: Trends in procedure mix, preoperative characteristics, and postoperative 30-day outcomes were compared. Multivariate analysis was used to identify independent risk factors for postoperative infection.RESULTS: Of 2002 patients who underwent IPAA, 1452 (72.5%) underwent 2-stage and 550 (27.5%) underwent 3-stage surgery. Since 2007, the distribution of 2- versus 3-stage procedures has not changed (p = 0.66). At the time of pouch surgery, patients who had undergone 3-stage surgery were less likely to have preoperative corticosteroid therapy, albumin <3 mg/dL, preoperative sepsis, and weight loss (all p < 0.05). Superficial surgical site infection was more common after 3-stage surgery (11.5% vs 7.3%; p < 0.01). After controlling for preoperative factors, wound classification was the only independent predictor of deep incisional or organ space infection (p < 0.01; OR, 1.76; 95% CI, 1.23-2.53).LIMITATIONS: This was a retrospective study.CONCLUSIONS: National trends of 2- versus 3-stage IPAA have remained stable over the last 5 years. Patients who underwent a 3-stage approach were healthier at the time of pouch surgery, with decreased corticosteroid use, hypoalbuminemia, and weight loss. Mixed results were seen for infectious complications with either approach. Prospective research is needed to determine the best approach to IPAA for chronic ulcerative colitis.

UR - http://www.scopus.com/inward/record.url?scp=84925283951&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925283951&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000000282

DO - 10.1097/DCR.0000000000000282

M3 - Article

C2 - 25585078

AN - SCOPUS:84925283951

VL - 58

SP - 199

EP - 204

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 2

ER -