title: Sepsis is a major predictor of failure after ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  This study aimed to determine the risk of ileal pouch-anal anastomosis failure and factors predictive of failure overall and in patients with septic complications.
  
  
  METHODS
  Patients were identified through a prospectively maintained patient registry. All patients registered in the Mount Sinai Hospital Inflammatory Bowel Disease database who had an ileal pouch-anal anastomosis for more than 12 months were included in the study. Pouch failure was defined as ileal pouch-anal anastomosis excision or permanent diversion. Cox proportional hazard models with death as a competing risk were created, modeling time to failure as the outcome of interest for all patients and for the subgroup of patients with septic complications.
  
  
  RESULTS
  The study included 1,554 patients. One hundred six patients experienced an ileal pouch-anal anastomosis failure (6.8%), 49 (46.2%) of these failures were caused by septic complications. Independent predictors of failure included Crohn's disease (hazard ratio 7.5, 95% confidence interval [4.7, 12.0]) and postoperative sepsis (hazard ratio 6.6, 95% confidence interval [4.4, 9.8]). In the subgroup of patients with failure due to postoperative septic complications, independent predictors of failure were Crohn's disease (hazard ratio 2.7, 95% confidence interval [1.3, 5.7]) and presence of a pouch fistula (hazard ratio 2.6, 95% confidence interval [1.3, 5.2]).
  
  
  CONCLUSIONS
  Septic complications are the most common cause of ileal pouch-anal anastomosis failure. Careful patient selection and the prevention of septic complications may decrease the risk of this failure.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Forbes
authors.forename: Brenda I
authors.initials: BI
authors.lastname: O'Connor
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000328:Adult; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D018805:Sepsis / Q000150:complications*