Increased experience and surgical technique lead to improved outcome after ileal pouch-anal anastomosis: a population-based study.
OBJECTIVE
This study was designed to determine whether changes in length of stay and 30-day readmission, reoperation, and excision rates for the ileal pouch-anal anastomosis occurred over time and with changes in surgical technique and hospital volume.


METHODS
Using three population-based administrative databases, data on all ileal pouch-anal anastomoses performed in the province of Ontario between January 1992 and June 1998 were obtained. The effect of age, gender, stage of the procedure, year of surgery, and hospital volume were examined for their effect on length of stay and readmission, reoperation, and excision rates.


RESULTS
There were 1,285 ileal pouch-anal anastomoses performed in 58 hospitals. There was a significant decrease in length of stay and reoperation and excision rates but a concommitant increase in readmission rate during the study period. Patients younger than aged 40 years had a significantly lower length of stay and excision rate. Patients who had a two-stage procedure had a shorter length of stay, readmission, and reoperative rate compared with those having a three-stage procedure. Hospital volume was a significant predictor of need for reoperation and excision with both low-volume and medium-volume hospitals having significantly higher rates than high-volume hospitals.


CONCLUSIONS
Outcome after ileal pouch-anal anastomosis has improved. It is significantly better in patients younger than aged 40 years, having a two-stage procedure, and where surgery is performed at high-volume hospitals. It is likely that both modifications in surgical technique and surgical experience have led to improvements in clinical outcome after ileal pouch-anal anastomosis.
Kennedy
E D
ED
Department of Surgery and the Mount Sinai Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Rothwell
D M
DM
Cohen
Z
Z
McLeod
R S
RS
D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D039021:Colonic Pouches / Q000009:adverse effects* / Q000706:statistics & numerical data; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009864:Ontario; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome