National Trends of 3- Versus 2-Stage Restorative Proctocolectomy for Chronic Ulcerative Colitis

BACKGROUND:Patients undergoing surgical treatment of chronic ulcerative colitis usually undergo a staged approach to IPAA. OBJECTIVE:The purpose of this work was to identify the national trends in approach to IPAA for chronic ulcerative colitis and to evaluate 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program. DESIGN:This was a retrospective review study SETTINGS:This study was conducted at a tertiary care cancer center. PATIENTS:Patients with chronic ulcerative colitis who underwent IPAA from 2005 to 2011 were identified. Those who underwent colectomy with pouch procedure were placed in a 2-stage cohort, and those without simultaneous colectomy were part of a 3-stage cohort. Emergent operations were excluded. MAIN OUTCOME MEASURES:Trends in procedure mix, preoperative characteristics, and postoperative 30-day outcomes were compared. Multivariate analysis was used to identify independent risk factors for postoperative infection. RESULTS:Of 2002 patients who underwent IPAA, 1452 (72.5%) underwent 2-stage and 550 (27.5%) underwent 3-stage surgery. Since 2007, the distribution of 2- versus 3-stage procedures has not changed (p = 0.66). At the time of pouch surgery, patients who had undergone 3-stage surgery were less likely to have preoperative corticosteroid therapy, albumin