Pellino G, Reif de Paula T, Lawlor G, Keller D S
Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.
Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
Tech Coloproctol. 2020 Aug 16. doi: 10.1007/s10151-020-02327-1.
Ileal pouch-anal anastomosis (IPAA) for ulcerative colitis(UC) can be performed as either 2- or 3-stage procedure. IPAA in the elderly has been reported as safe and feasible, but little work to date has assessed outcomes by procedure. The aim of our study was to assess use and short-term outcomes of 2- and 3-stage IPAA in older adults.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was searched for ≥ 65-year-old patients who underwent IPAA for UC in 2- or 3-stage from 2012 to 2016. The primary endpoint was the rate and trends of the two approaches over time. Secondary endpoints included 30-day adverse events and complication-associated costs.
Overall, 123 patients were included: 77.5% (n = 83) 2-stage and 40 (32.5%) 3-stage IPAA. Mean age was 68.7 ± 3.9 years, with 43 (34.9%) women. The use of the 3-stage IPAA increased over time (18.8% in 2012 vs. 33.3% in 2016), with decreasing use of 2-stage IPAA(81.3% vs. 66.7%, p < 0.001). The morbidity associated with the procedures decreased over time, overall (81.3% in 2012 and 51.5% in 2016, p < 0.001) and in each group individually. No differences were observed in postoperative complications across groups (45.8% 2-stage, 32.5% 3-stage). The overall mean costs of care when no postoperative complications occurred was $25,910, vs. $38,577 when any complication occurred (p < 0.001), but no differences were observed between groups.
In a national analysis, there was a trend of increasing 3-stage vs. 2-stage IPAA for UC in older Americans. Complications and complication-associated costs were comparable across approaches, suggesting that the choice of procedure type should be based on the specific patient comorbidities and surgeon preferences.
溃疡性结肠炎（UC）的回肠储袋肛管吻合术（IPAA）可分为两阶段或三阶段进行。据报道，老年患者行IPAA手术是安全可行的，但迄今为止，很少有研究按手术方式评估其结局。我们研究的目的是评估老年人两阶段和三阶段IPAA的应用情况及短期结局。
检索美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，查找2012年至2016年间因UC接受两阶段或三阶段IPAA手术的65岁及以上患者。主要终点是两种手术方式随时间的发生率和趋势。次要终点包括30天不良事件和并发症相关费用。
共纳入123例患者：两阶段IPAA 83例（77.5%），三阶段IPAA 40例（32.5%）。平均年龄为68.7±3.9岁，女性43例（34.9%）。三阶段IPAA的应用随时间增加（2012年为18.8%，2016年为33.3%），而两阶段IPAA的应用减少（81.3%对66.7%，p<0.001）。手术相关的发病率随时间总体下降（2012年为81.3%，2016年为51.5%，p<0.001），且每组均单独下降。各手术组术后并发症发生率无差异（两阶段为45.8%，三阶段为32.5%）。无术后并发症时的总体平均护理费用为25,910美元，发生任何并发症时为38,577美元（p<0.），但两组间无差异。
在一项全国性分析中，美国老年UC患者行三阶段IPAA与两阶段IPAA相比有增加趋势。不同手术方式的并发症及并发症相关费用相当，这表明手术方式的选择应基于患者的具体合并症及外科医生的偏好。
