Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis

Anders Mark-Christensen; Rune Erichsen; Søren Brandsborg; Frederik Rønne Pachler; Charlotte Buchard Nørager; Niels Bent Johansen; Jørn Helmut Pachler; Ole Thorlacius-Ussing; Mie Dilling Kjaer; Niels Qvist; Louise Preisler; Jens Hillingsø; Jacob Rosenberg; Søren Laurberg

doi:10.1111/codi.13802

Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis

Anders Mark-Christensen, Rune Erichsen, Søren Brandsborg, Frederik Rønne Pachler, Charlotte Buchard Nørager, Niels Bent Johansen, Jørn Helmut Pachler, Ole Thorlacius-Ussing, Mie Dilling Kjaer, Niels Qvist, Louise Preisler, Jens Hillingsø, Jacob Rosenberg, Søren Laurberg

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

AIM: Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure.

METHOD: The study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.

RESULTS: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.

CONCLUSION: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

Original language	English
Journal	Colorectal Disease
Volume	20
Issue number	1
Pages (from-to)	44-52
Number of pages	9
ISSN	1462-8910
DOIs	https://doi.org/10.1111/codi.13802
Publication status	Published - Jan 2018

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Mark-Christensen, A., Erichsen, R., Brandsborg, S., Rønne Pachler, F., Nørager, C. B., Johansen, N. B., Pachler, J. H., Thorlacius-Ussing, O., Dilling Kjaer, M., Qvist, N., Preisler, L., Hillingsø, J., Rosenberg, J., & Laurberg, S. (2018). Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis. Colorectal Disease, 20(1), 44-52. Advance online publication. https://doi.org/10.1111/codi.13802

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title = "Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis",

abstract = "AIM: Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure.METHOD: The study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.RESULTS: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.CONCLUSION: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.",

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author = "Anders Mark-Christensen and Rune Erichsen and S{\o}ren Brandsborg and {R{\o}nne Pachler}, Frederik and N{\o}rager, {Charlotte Buchard} and Johansen, {Niels Bent} and Pachler, {J{\o}rn Helmut} and Ole Thorlacius-Ussing and {Dilling Kjaer}, Mie and Niels Qvist and Louise Preisler and Jens Hillings{\o} and Jacob Rosenberg and S{\o}ren Laurberg",

note = "Colorectal Disease {\textcopyright} 2017 The Association of Coloproctology of Great Britain and Ireland.",

year = "2018",

month = jan,

doi = "10.1111/codi.13802",

language = "English",

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Mark-Christensen, A, Erichsen, R, Brandsborg, S, Rønne Pachler, F, Nørager, CB, Johansen, NB, Pachler, JH, Thorlacius-Ussing, O, Dilling Kjaer, M, Qvist, N, Preisler, L, Hillingsø, J, Rosenberg, J & Laurberg, S 2018, 'Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis', Colorectal Disease, vol. 20, no. 1, pp. 44-52. https://doi.org/10.1111/codi.13802

TY - JOUR

T1 - Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis

AU - Mark-Christensen, Anders

AU - Erichsen, Rune

AU - Brandsborg, Søren

AU - Rønne Pachler, Frederik

AU - Nørager, Charlotte Buchard

AU - Johansen, Niels Bent

AU - Pachler, Jørn Helmut

AU - Thorlacius-Ussing, Ole

AU - Dilling Kjaer, Mie

AU - Qvist, Niels

AU - Preisler, Louise

AU - Hillingsø, Jens

AU - Rosenberg, Jacob

AU - Laurberg, Søren

PY - 2018/1

Y1 - 2018/1

N2 - AIM: Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure.METHOD: The study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.RESULTS: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.CONCLUSION: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

AB - AIM: Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure.METHOD: The study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.RESULTS: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.CONCLUSION: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

KW - Journal Article

U2 - 10.1111/codi.13802

DO - 10.1111/codi.13802

M3 - Journal article

C2 - 28667683

SN - 1462-8910

VL - 20

SP - 44

EP - 52

JO - Colorectal Disease

JF - Colorectal Disease

IS - 1

ER -

Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis

Abstract

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