title: A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease.
abstract: BACKGROUND
  Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA.
  
  
  METHODS
  Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure.
  
  
  RESULTS
  A total of 640 patients [56.9% male] were included, with a median age of 38 years [interquartile range 29-48]; 96 [15.0%] patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index [BMI] > 25], (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.15 - 3.18), and American Society of Anesthesiologists classification [ASA score > 2] [OR 1.91; 95% CI 1.03 - 3.54] were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years [OR 2.34; 95% CI 1.42 - 3.87] and concurrent combination of anti-tumour necrosis factor [TNF] and steroids [OR 6.40; 95% CI 1.76 - 23.20] were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA.
  
  
  CONCLUSIONS
  Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Saloomeh
authors.initials: S
authors.lastname: Sahami
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sanne A L
authors.initials: SA
authors.lastname: Bartels
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: D'Hoore
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
authors.forename: Tonia Young
authors.initials: TY
authors.lastname: Fadok
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.affiliation: Divisions of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Lindeboom
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Anthony
authors.initials: A
authors.lastname: de Buck van Overstraeten
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Albert M
authors.initials: AM
authors.lastname: Wolthuis
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands c.j.buskens@amc.uva.nl.
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Buskens
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Ileal pouch-anal anastomosis; anastomotic leakage; risk factors