Outcomes after ileoanal pouch surgery in frail and older adults.
BACKGROUND
Evidence from single-center studies suggests that ileal pouch-anal anastomosis (IPAA) can be safely performed in selected older patients with ulcerative colitis. The impact of age and frailty on surgical outcomes and hospital length of stay after IPAA has not been examined.


METHODS
We identified all patients with ulcerative colitis who underwent total proctocolectomy or completion proctectomy with IPAA in the National Surgery Quality Improvement Program database from 2005-2012. We examined the associations of age and frailty trait count with length of hospital stay and surgical complications using multivariate regression.


RESULTS
IPAA was performed in 2493 patients with ulcerative colitis. Thirty-day mortality was 0.2% (n = 6). The majority of patients had no serious postoperative complications (age ≤50 y: 79.5%, age 51-60 y: 80.4%, and age >60 y: 79.1%). After multivariate risk adjustment, patients aged >60 y had a similar mean number of complications as patients aged ≤50 y (0.31 versus 0.35, P = 0.47) and a 0.8-d longer mean length of hospital stay (7.4 versus 8.2 d, P = 0.035). Compared to patients with zero frailty traits, a frailty trait count ≥1 was associated with a similar mean number of complications (0.31 versus 0.34, P = 0.36) and length of hospital stay (7.4 versus 7.7 d, P = 0.25).


CONCLUSIONS
In this analysis of patients undergoing IPAA at National Surgery Quality Improvement Program hospitals, surgical complications were not substantially increased in older patients or those with frailty traits. Older age was associated with a small increase in hospital length of stay. These findings suggest that IPAA is safe in selected older adults with ulcerative colitis.
Department of Surgery, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California. Electronic address: Jessica.Cohan@ucsf.edu.
Jessica N
JN
Cohan
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Peter
P
Bacchetti
Department of Surgery, University of California, San Francisco, San Francisco, California.
Madhulika G
MG
Varma
Department of Surgery, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California; Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.
Emily
E
Finlayson
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
Frailty; Geriatric surgery; Ileal pouch-anal anastomosis; Surgical outcomes; Ulcerative colitis