title: Early postoperative complications have long-term impact on quality of life after restorative proctocolectomy.
abstract: BACKGROUND
  Early postoperative complications graded according to the Clavien-Dindo classification system have not previously been correlated with long-term quality of life outcomes in patients who have had restorative proctocolectomy with ileal pouch-anal anastomosis. This study aimed to assess the severity of early postoperative complications and compared these in terms of the long-term quality of life after restorative proctocolectomy in a population-based cohort of patients (operated on from 1984 to 2013). It was hypothesized that those who experienced grade 3 or 4 Clavien-Dindo complications would have worse quality of life at follow-up.
  
  
  METHODS
  This population-based study used a combination of a retrospective note review and a cross-sectional questionnaire. All patients with a restorative proctocolectomy performed in 1984-2013 in the Canterbury region were recruited using multiple sources. Early (≤30 days) and late (>30 days) complication rates were obtained via patient records. Early postoperative complications were graded according to the Clavien-Dindo classification. Quality of life was measured using the inflammatory bowel disease questionnaire.
  
  
  RESULTS
  One hundred and thirty-six people were identified with a median follow-up of 12 years. Data were available for 121 patients for early complications and 112 for late complications. Eighty-one eligible participants had their quality of life assessed (86% response rate). Early complications occurred in 26% and 76% had late complications. Those who had Clavien-Dindo grade 3 or 4 early complications had lower quality of life scores (P = 0.001) as did females (P = 0.004) and those with a stricture (P = 0.031).
  
  
  CONCLUSIONS
  This population-based study with long-term follow-up demonstrates that Clavien-Dindo grade 3 and 4 postoperative complications are important in determining quality of life in the long term. The reduction in these complications should be a focus of patient management, as it should improve long-term quality of life.
authors.affiliation: University of Otago, Christchurch, New Zealand Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: McCombie
authors.forename: Yun
authors.initials: Y
authors.lastname: Lee
authors.forename: Rutvik
authors.initials: R
authors.lastname: Vanamala
authors.forename: Richard
authors.initials: R
authors.lastname: Gearry
authors.forename: Frank
authors.initials: F
authors.lastname: Frizelle
authors.forename: Emma
authors.initials: E
authors.lastname: McKay
authors.forename: Jonathan
authors.initials: J
authors.lastname: Williman
authors.forename: Tim
authors.initials: T
authors.lastname: Eglinton
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011788:Quality of Life; D012189:Retrospective Studies; D057566:Self Report; D013997:Time Factors