title: Gender of the patient may influence perioperative and long-term complications after restorative proctocolectomy.
abstract: OBJECTIVE
  Gender-related differences in preoperative characteristics and early and long-term outcome for patients undergoing ileal pouch anal anastomosis (IPAA) have not previously been well studied.
  
  
  METHODS
  All male and female patients undergoing IPAA at a single centre between 1983 and 2008 were compared for perioperative variables and long-term outcome. Statistical tests were used as appropriate. A multivariate analysis was performed to evaluate the effects of gender on pouch failure.
  
  
  RESULTS
  Female patients (n=1495) were younger than male patients (n=1912) (P<0.001). Surgery type and pouch configuration were similar, although male gender was associated with a higher use of ileostomy (P<0.001) and a higher incidence of 30-day anastomotic separation (P=0.001). During a median follow up of 9.9 (female) and 9.3 (male) years, female patients were more likely to develop bowel obstruction (20.8 vs 16.7%, P=0.02) and pouch-related fistula (10.9 vs 7.6%, P=0.001). Women had a higher number of daily bowel movements than men (P=0.001), and more frequently had urgency (P=0.001), daily seepage (P=0.01) and pad use (P<0.001). A higher percentage of female patients reported dietary (P<0.001) and work (P=0.022) restrictions and lower mental component of the Short-Form 36 quality of life score (P=0.018). On multivariate analysis of perioperative variables, female gender was associated with pouch failure (P=0.05).
  
  
  CONCLUSIONS
  The gender of the patient seems to be associated with specific differences in preoperative variables and postoperative outcomes for patients undergoing IPAA.
authors.affiliation: Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: M
authors.initials: M
authors.lastname: Rottoli
authors.forename: F H
authors.initials: FH
authors.lastname: Remzi
authors.forename: B
authors.initials: B
authors.lastname: Shen
authors.forename: R P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012737:Sex Factors; D016896:Treatment Outcome