Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome?
OBJECTIVE
Functional outcome and quality of life in older patients (>55 years) undergoing ileal pouch-anal anastomosis (IPAA) for ulcerative colitis or familial adenomatous polyposis have been incompletely studied. Our aim was to update our understanding on how the age of the patient at the time of surgery influences functional outcome and quality of life after IPAA.


METHODS
From January 1, 1981, to December 31, 2000, two thousand two patients who underwent IPAA were studied. Patients were grouped by age at operation: 45 years or younger (n = 1688), between 46 and 55 years (n = 249), and older than 55 years (n = 65). Mean age was 33.5 years. Postoperative complications, function, and quality of life were assessed with a questionnaire administered annually.


RESULTS
Follow-up for patients older than 55 years was a mean +/- SD of 8.1 +/- 4.8 years. Overall, follow-up was a mean of 10.1 +/- 5.7 years. The pouch failure rate for patients older than 55 years was 1.6% at 10 years. No statistically significant difference in pouch failure between age groups was observed. Overall, frequent daytime and nighttime incontinence, respectively, occurred in 5.6% and 13.3% of the patients at 10 years. Incontinence was more common in older patients (P = .002 at 3 years). Quality of life as assessed by social activities, work, travel, sexual activity, family relationships, and sports and recreation was not significantly different among age groups. Most patients felt that their condition had improved or that they had no restrictions after IPAA.


CONCLUSIONS
Postoperative complications after surgery seem to be unrelated to age at the time of surgery. Although incontinence may occur more frequently in older patients, IPAA does not adversely affect quality of life in patients older than 55 years.
Chapman
Jennifer R
JR
Division of Colorectal Surgery and the Department of Biostatistics, Mayo Clinic and Mayo Foundation, Mayo Clinic College of Medicine, Rochester, Minn, USA.
Larson
David W
DW
Wolff
Bruce G
BG
Dozois
Eric J
EJ
Cima
Robert R
RR
Pemberton
John H
JH
Crownhart
B S
BS
Larson
Dirk R
DR
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000367:Age Factors; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D039021:Colonic Pouches; D003424:Crohn Disease / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome