title: Probability, rate and timing of reconstructive surgery following colectomy for inflammatory bowel disease in Sweden: a population-based cohort study.
abstract: OBJECTIVE
  Many patients with inflammatory bowel disease (IBD) need colectomy, but the rate of reconstructive surgery with restoration of intestinal continuity is unknown. The aim of this study was to investigate the probability, rate and timing of reconstructive surgery after colectomy in patients with IBD in a population-based setting.
  
  
  METHODS
  The study cohort included all patients with IBD in Sweden who underwent colectomy from 2000 to 2009. Each patient was followed from admission for colectomy to admission for reconstructive surgery, date of death, migration or 31 December 2010. Kaplan-Meier survival curves and multivariable Poisson regression models were used to describe the probability, rate and timing of reconstructive surgery.
  
  
  RESULTS
  Out of 2818 IBD patients treated with colectomy, 61.0% were male and 78.9% had ulcerative colitis. No reconstructive surgery had been performed in 1595 (56.6%) patients by the end of follow-up. Of the remaining 1223 patients, 526 underwent primary reconstructive surgery and 697 had a secondary reconstruction following a median interval of 357 days from primary surgery in the form of colectomy. The probability of reconstructive surgery was dependent on age (55.6% and 18.1% at ages 15-29 and ≥ 59 years, respectively), and the chance of reconstructive surgery was higher in hospitals that performed more than 13 colectomies for IBD per year [incidence rate ratio and 95% confidence interval 1.27 (1.09-1.49)].
  
  
  CONCLUSIONS
  Fewer than half of the patients having a colectomy for IBD underwent subsequent reconstructive surgery. Older age and low hospital volume were risk factors for no reconstructive surgery.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden.|Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Nordenvall
authors.affiliation: Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.|Department of Surgery, County Council of Östergötland, Linköping, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Myrelid
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Ekbom
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Bottai
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: K E
authors.initials: KE
authors.lastname: Smedby
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.|Department of Paediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Olén
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden.|Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: P J
authors.initials: PJ
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery; D003424:Crohn Disease / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011336:Probability; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Inflammatory bowel disease; colectomy; ileal pouch-anal anastomosis; ileorectal anastomosis; reconstructive surgery