Long-term quality of life associated with early surgical complications in patients with ulcerative colitis after ileal pouch–anal anastomosis: A single-center retrospective study

Abstract

BackgroundIleal pouch-anal anastomosis (IPAA) is recommended for patients with ulcerative colitis (UC) in terms of surgical treatment. Measuring surgical complications of IPAA and long-term quality of life (QOL) are important to achieve an acceptable risk/benefit ratio for patients with UC. Materials and methodsPatients with UC who underwent total proctocolectomy (TPC) with IPAA from February 2008 to July 2016 at our institute were included. Early surgical complications were defined as mechanical/infectious events within one month after IPAA. Assessment of QOL was performed using the Cleveland Global Quality of Life instrument (CGQL), with 50% improvement as a cut-off value. Demographic and clinical variables were compared with univariable analysis and step-wise logistic regression models were also performed. ResultsA total of 58 eligible patients had a median follow-up time of 78.5 months [interquartile range (IQR), 34.4–92.8] from February2008 to March 2017, including 25 cases (43.1%) developed early surgical complications. Age at pouch surgery and excessive blood loss were risk factors associated with early surgical complications (p < 0.05). In multivariate analysis, older age at surgery [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.01–1.1] and significant blood loss (≧400 ml) (OR, 4.31; 95% CI, 1.21–16.87) were contributing factors for developing early surgical complications. The CGQL score was significantly increased after IPAA (0.728 ± 0.151 vs. 0.429 ± 0.173, p < 0.001). Early surgical complications (OR, 5.55; 95%CI, 1.44–21.37), older age at surgery (OR, 1.06; 95% CI, 1.01–1.12) and use of immunomodulatory (OR, 17.50; 95% CI, 1.52–201.39) were associated with poor long-term QOL. ConclusionThe study demonstrated that early surgical complications might contribute to develop a poor CGQL score, suggesting intentional control of risk factors associated with early surgical complications should be taken into consideration for patients with UC for pouch surgery.