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P492 Perioperative complications have long-term effect on quality of life after restorative proctocolectomy

Y. Lee1, A. McCombie*1, 2, R. Vanamala1, R. Gearry3, F. Frizelle1, E. McKay1, J. Williman4, T. Eglinton1

1University of Otago, Department of Surgery, Christchurch, New Zealand, 2University of Otago, Department of Medicine, Dunedin, New Zealand, 3University of Otago, Department of Medicine, Christchurch, New Zealand, 4University of Otago, Christchurch, Department of Population Health, Christchurch, New Zealand

Background

Ileal pouch anal anastomosis (IPAA) is commonly performed for ulcerative colitis (UC), indeterminate colitis (IC), and familial adenomatous polyposis (FAP). However, IPAA is not without complications. This study aimed to retrospectively determine the complication rates of patients who had IPAA performed in Canterbury, New Zealand, from 1984 to 2013, and to measure the quality of life (QoL) of all people with completed IPAAs in 2013. It was hypothesised that those who experienced grade 3 or 4 Clavien–Dindo complications1 would have worse QoL at follow-up.

Methods

All patients with an IPAA procedure performed in 1984–2013 in Canterbury were recruited using multiple sources. Early (≤ 30 days) and late (> 30 days) complication rates were obtained via patient notes. Perioperative complications were graded according to the Clavien–Dindo classification system, wherein grades range from 0 (no intervention) to 5 (death). QoL was measured using the Inflammatory Bowel Disease Questionnaire (IBDQ) in 2013.

Results

Figure 1 shows 136 people (104 UC, 5 IC, 15 CD, 12 FAP, and 1 Lynch syndrome; 55.1% male; mean age 50) had IPAA performed in the study period (median time since IPAA surgery 12 years). Data were available for 121 patients for early complications and 112 for late complications. Eighty-one eligible participants completed the IBDQ (86.2% response rate).

Figure 1. Participant identification and recruitment.

At least 1 early complication (ie, haemorrhage requiring transfusion, wound infection, pelvic sepsis, or small bowel obstruction) occurred in 26.4% of IPAA recipients, whereas 75.9% had at least 1 late complication (ie, small bowel obstruction, pouchitis, abscess/fistula, stricture, or pouch failure) and 13.0 % had a failed IPAA. Table 1 shows the people who had lower QoL. Of note was that those who had perioperative grade 3 or 4 complications had lower IBDQ (p < 0.01) as did females (p < 0.01) and those with a stricture (p < 0.05). Those with failed pouches did not have inferior IBDQ scores.

Table 1 Early and late complications

VariableIBDQ 
mean (SD)versusIBDQ 
mean (SD)p-value
All participants170.3N/AN/AN/A
Female160.1 (29.7)Male178.0 (24.7)< 0.01
Early small bowel 
obstruction128.0 (45.3)No early complications174.0 (26.1)< 0.01
Early 
pelvic sepsis146.2 (10.1)No early complications174.0 (26.1)< 0.01
Any early 
complications156.0 (32.2)No early complications174.0 (26.1)< 0.05
Any 
Grade 3 or 4 
complications136.9 (26.3)No early complications174.0 (26.1)< 0.01
Late stricture151.7 (38.7)No late complications177.2 (27.2)< 0.05
≥ 7 bowel 
motions/day163.2 (25.6)< 7 bowel motions/day176.5 (29.4)< 0.05

Conclusion

This population-based study with long-term follow-up demonstrates that Grade 3 and 4 perioperative complications are important in determining QoL in the long-term. Despite the high rate of complications in the long term, most people with IPAA have a normal QoL, including those with a failed IPAA (and subsequent stoma).

References

[1] Clavien P, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–96.