Background: Ulcerative colitis (UC) patients requiring colectomy often have a staged ileal pouch anal anastomosis (IPAA). There are no prospective data comparing timing of pouch creation. We aimed to compare 30-day adverse event (AE) rates for pouch creation at the time of colectomy (PTC) with delayed pouch creation (DPC). Methods: Using prospectively collected data between 2011-2015 through the National Surgical Quality Improvement Program, we conducted a cohort study including subjects ≥18 years with a post-operative diagnosis of UC. We assessed 30-day post-operative rates of unplanned readmissions, reoperations, major and minor AEs, comparing the stage of surgery where pouch creation took place. In a sub-analysis, we assessed AEs for those undergoing a total abdominal colectomy with ileostomy (TAC). Using a modified Poisson regression model, we estimated risk ratios (RR) with 95% confidence intervals (CI) adjusting for age, sex, race, BMI, smoking, diabetes, albumin and co-morbidities. Results: Of 2,390 IPAA procedures, 1,571 were PTC and 819 were DPC. In the PTC group, 51% were on chronic immunosuppression pre-operatively, compared with 15% in the DPC group (p<0.01) (Table1). AE rates are in Figure1. After controlling for confounders, patients who had DPC were significantly less likely to have unplanned reoperations (RR 0.42, 95%CI 0.24-0.75), major AEs (RR 0.72, 95%CI 0.52-0.99), and minor AEs (RR 0.48, 95%CI 0.32-0.73) than PTC. There were 2,460 TAC patients; 69% were on chronic immunosuppression. Controlling for confounders, TAC had a significantly lower risk of unplanned readmissions (RR: 0.69, 95%CI 0.58-0.81), major AEs (RR: 0.68, 95%CI: 0.54-0.84) and minor AEs (RR: 0.79, 95%CI: 0.63-0.98) compared to PTC. Conclusions: Patients undergoing delayed pouch creation were at lower risk for unplanned reoperations, major and minor AEs compared with patients undergoing PTC. Immunosuppression at the time of pouch creation may be influencing post-operative outcomes.
