Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch-Anal anastomosis (IPAA)

Coen L. Klos, Bashar Safar, Nida Jamal, Steven R. Hunt, Paul E. Wise, Elisa H. Birnbaum, James W. Fleshman, Matthew G. Mutch, Sekhar Dharmarajan

Research output: Contribution to journalArticle

Abstract

Purpose: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA. Methods: This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI <30 (non-obese) and BMI ≥ 30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate. Results: A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 % vs. 64 %, p = 0.03), primarily accounted for by increased pouch-related complications (61 % vs. 26 %, p <0.01). In particular, obese patients had more anastomotic/pouch strictures (27 % vs. 6 %, p <0.01), inflammatory pouch complications (17 % vs. 4 %, p <0.01) and pouch fistulas (12 % vs. 3 %, p = 0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR] = 2.86, p = 0.01) for pouch-related complications. Conclusions: Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.

Original languageEnglish (US)
Pages (from-to)573-579
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Restorative Proctocolectomy
Colonic Pouches
Obesity
Body Mass Index
Adenomatous Polyposis Coli
Ulcerative Colitis
Fistula
Pathologic Constriction
Odds Ratio
Demography

Keywords

  • Complications
  • Obesity
  • Restorative proctocolectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch-Anal anastomosis (IPAA). / Klos, Coen L.; Safar, Bashar; Jamal, Nida; Hunt, Steven R.; Wise, Paul E.; Birnbaum, Elisa H.; Fleshman, James W.; Mutch, Matthew G.; Dharmarajan, Sekhar.

In: Journal of Gastrointestinal Surgery, Vol. 18, No. 3, 03.2014, p. 573-579.

Research output: Contribution to journalArticle

Klos, Coen L. ; Safar, Bashar ; Jamal, Nida ; Hunt, Steven R. ; Wise, Paul E. ; Birnbaum, Elisa H. ; Fleshman, James W. ; Mutch, Matthew G. ; Dharmarajan, Sekhar. / Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch-Anal anastomosis (IPAA). In: Journal of Gastrointestinal Surgery. 2014 ; Vol. 18, No. 3. pp. 573-579.
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abstract = "Purpose: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA. Methods: This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI <30 (non-obese) and BMI ≥ 30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate. Results: A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 {\%} vs. 64 {\%}, p = 0.03), primarily accounted for by increased pouch-related complications (61 {\%} vs. 26 {\%}, p <0.01). In particular, obese patients had more anastomotic/pouch strictures (27 {\%} vs. 6 {\%}, p <0.01), inflammatory pouch complications (17 {\%} vs. 4 {\%}, p <0.01) and pouch fistulas (12 {\%} vs. 3 {\%}, p = 0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR] = 2.86, p = 0.01) for pouch-related complications. Conclusions: Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.",
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T1 - Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch-Anal anastomosis (IPAA)

AU - Klos, Coen L.

AU - Safar, Bashar

AU - Jamal, Nida

AU - Hunt, Steven R.

AU - Wise, Paul E.

AU - Birnbaum, Elisa H.

AU - Fleshman, James W.

AU - Mutch, Matthew G.

AU - Dharmarajan, Sekhar

PY - 2014/3

Y1 - 2014/3

N2 - Purpose: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA. Methods: This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI <30 (non-obese) and BMI ≥ 30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate. Results: A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 % vs. 64 %, p = 0.03), primarily accounted for by increased pouch-related complications (61 % vs. 26 %, p <0.01). In particular, obese patients had more anastomotic/pouch strictures (27 % vs. 6 %, p <0.01), inflammatory pouch complications (17 % vs. 4 %, p <0.01) and pouch fistulas (12 % vs. 3 %, p = 0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR] = 2.86, p = 0.01) for pouch-related complications. Conclusions: Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.

AB - Purpose: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA. Methods: This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI <30 (non-obese) and BMI ≥ 30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate. Results: A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 % vs. 64 %, p = 0.03), primarily accounted for by increased pouch-related complications (61 % vs. 26 %, p <0.01). In particular, obese patients had more anastomotic/pouch strictures (27 % vs. 6 %, p <0.01), inflammatory pouch complications (17 % vs. 4 %, p <0.01) and pouch fistulas (12 % vs. 3 %, p = 0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR] = 2.86, p = 0.01) for pouch-related complications. Conclusions: Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.

KW - Complications

KW - Obesity

KW - Restorative proctocolectomy

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DO - 10.1007/s11605-013-2353-8

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JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

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