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.
  
  
  METHODS
  This was a retrospective review study
  
  
  METHODS
  : This study was conducted at a tertiary care cancer center.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 2Department of Surgery, Mayo Clinic, Rochester, Minnesota 3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jai
authors.initials: J
authors.lastname: Bikhchandani
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagie
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods* / Q000639:trends; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D016896:Treatment Outcome