title: Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review.
abstract: OBJECTIVE
  Ileal pouch-anal anastomosis (IPAA) is performed in ulcerative colitis or familial adenomatous polyposis with a view to restoration of GI continuity and prevention of permanent faecal diversion. Debate exists as to its safety in older patients. This review aims to assess functional outcomes and safety of restorative proctocolectomy (RPC) in older compared to younger patients.
  
  
  METHODS
  Literature search was performed for age-stratified studies which assessed functional outcomes of IPAA. Twelve papers were included overall. Patients were categorized into 'older' and 'younger' groups. Analysis was split into three separate parts: 1. Age cut-off of 50 ± 5 years (with sensitivity analysis); 2. Age cut-off of 65 ± years; 3. Long-term outcomes (>10 years).
  
  
  RESULTS
  With an age cut-off of 50 years (4327 versus 513 patients), complication rates were comparable with the exception of an increased rate of small-bowel obstruction in the younger patients (p = 0.034). At 1 year, 24-h stool frequency was significantly higher in the older patient group (p < 0.0001). Daytime (p < 0.0001) and night-time (p < 0.0001) incontinence rates were also significantly higher in older patients. Overall, function deteriorated with time across all ages; however, after 10 years, there was no significant difference in incontinence rates between age groups. Dehydration and electrolyte loss was a significant problem in patients over 65 (p < 0.0001). Despite differences in postoperative function, quality of life was comparable between groups; however, only a few studies reported quality of life data.
  
  
  CONCLUSIONS
  IPAA is safe in older patients, although treating clinicians should bear in mind the increased risk of dehydration. Postoperative function is worse in older patients, but seems to level out with time and does not appear to significantly impact on overall quality of life and patient satisfaction. Assessment for suitability for RPC should not be based on chronological age in isolation. It is imperative that the correct support is given to older patients with worsened postoperative function in order to maintain patient satisfaction and adequate quality of life.
authors.affiliation: Colorectal Surgery, Imperial College London, London, UK.|Department of Surgery and Cancer, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ramage
authors.affiliation: Colorectal Surgery, Imperial College London, London, UK.|Department of Surgery and Cancer, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
authors.forename: Sheng
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Colorectal Surgery, Imperial College London, London, UK.|Department of Surgery and Cancer, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Georgiou
authors.affiliation: Colorectal Surgery, Imperial College London, London, UK.|Department of Surgery and Cancer, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
authors.forename: Paris
authors.initials: P
authors.lastname: Tekkis
authors.affiliation: Colorectal Surgery, Imperial College London, London, UK. e.tan@imperial.ac.uk.|Department of Surgery and Cancer, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK. e.tan@imperial.ac.uk.
authors.forename: Emile
authors.initials: E
authors.lastname: Tan
mesh_terms: D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical; D039021:Colonic Pouches / Q000473:pathology*; D003710:Demography; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome
keywords: Age; Ileal pouch-anal anastomosis (IPAA); Postoperative function; Restorative proctocolectomy (RPC)