Adams Ursula C, Agala Chris B, Barnes Edward L, Stem Jonathan M, Charles Anthony G, Phillips Michael R
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Am Surg. 2025 Feb;91(2):273-280. doi: 10.1177/00031348241295271. Epub 2024 Oct 24.
The impact of diverting ileostomy in adults with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) is unclear. This study uses a novel approach with population-level data to identify patients with diverting ileostomy at the time of IPAA and determine the impact of diverting ileostomy on postoperative outcomes.
Using the International Business Machines (IBM) MarketScan® database, adults (18-64 years old) with a diagnosis of UC who underwent IPAA between 2000 and 2019 were examined. Patients were assigned to the diverting ileostomy (DI) cohort or no-DI cohort based on the presence of an ostomy closure code in the 1-year following their IPAA. Rates of ileostomy formation and readmissions were quantified and outcomes between cohorts compared.
There were 540 patients in the no-DI and 2494 in the DI cohort. There were regional differences in the rate of ostomy creation, but the overall rate of ostomy creation remained stable across years. Patients with no-DI vs DI had a longer index length of stay (LOS) (7 vs 6 days, = .001). Adverse postoperative outcomes did not differ between cohorts. Diversion did not independently affect the likelihood of a 30-day readmission, and since 2000, readmission rates have declined for all IPAA patients.
This is the first study to capture population-level data on the effect of diversion at the time of IPAA for adult UC patients. This study demonstrates that the rate of fecal diversion at the time of IPAA has remained stable over time, but readmission rates have declined.
对于接受回肠储袋肛管吻合术（IPAA）的成年溃疡性结肠炎（UC）患者，行回肠造口术改道的影响尚不清楚。本研究采用一种新方法，利用人群水平的数据来识别IPAA手术时行回肠造口术改道的患者，并确定回肠造口术改道对术后结局的影响。
使用国际商业机器公司（IBM）的MarketScan®数据库，对2000年至2019年间接受IPAA手术的成年（18 - 64岁）UC诊断患者进行检查。根据IPAA术后1年内是否存在造口关闭代码，将患者分为回肠造口术改道（DI）队列或无DI队列。对回肠造口术形成率和再入院率进行量化，并比较队列间的结局。
无DI队列有540例患者，DI队列有2494例患者。造口形成率存在地区差异，但多年来造口形成的总体率保持稳定。无DI患者与DI患者相比，首次住院时间（LOS）更长（7天对6天，P = 0.001）。各队列术后不良结局无差异。改道并未独立影响30天再入院的可能性，自2000年以来，所有IPAA患者的再入院率均有所下降。
这是第一项收集成年UC患者IPAA手术时改道影响的人群水平数据的研究。本研究表明，IPAA手术时粪便改道率随时间保持稳定，但再入院率有所下降。
