Aquina, Christopher T., Fleming, Fergal J., Becerra, Adan Z., Hensley, Bradley J., Noyes, Katia, Monson, John R. T., Temple, Larissa K., Cellini, Christina
abstract
Background. This study identified variation and factors associated with ileal pouch-anal anastomosis after total colectomy for ulcerative colitis. Methods. The Statewide Planning & Research Cooperative System was used to identify patients with ulcerative colitis who underwent total colectomy in New York state from 2000-2013. Bivariate and mixed effects multivariable analyses were performed to assess patient, surgeon, and hospital-level factors as well as surgeon and hospital-level variation associated with ileal pouch-anal anastomosis after total colectomy. Results. Across 2,203 patients, the rate of ileal pouch-anal anastomosis was 34%. Overall, 465 surgeons and 148 hospitals performed at least one total colectomy for ulcerative colitis from 2000-2013, and 178 surgeons and 80 hospitals performed at least one ileal pouch-anal anastomosis for ulcerative colitis during the study period. The median rate of ileal pouch-anal anastomosis creation was 14% (range = 6% to 69%) across surgeons and 14% (range = 7% to 63%) across hospitals. Patient-level factors independently associated with ileal pouch-anal anastomosis were younger age, lower comorbidity burden, and elective total colectomy. Surgeon and hospital-level factors independently associated with ileal pouch-anal anastomosis were colorectal surgery board-certification, surgeon ileal pouch-anal anastomosis volume, and hospital ileal pouch-anal anastomosis volume. Patient-level factors explained 43% of the surgeon and 47% of the hospital variation in ileal pouch-anal anastomosis creation while surgeon-level factors explained 26% of the surgeon and 21% of the hospital variation. Conclusion. These findings suggest that variation in ileal pouch-anal anastomosis creation for ulcerative colitis is influenced largely by provider practices/preferences or lack of referral of patients after colectomy to surgeons and centers that perform ileal pouch-anal anastomosis. Providers and hospitals that do not routinely perform ileal pouch-anal anastomosis should refer patients to centers with ileal pouch-anal anastomosis expertise after total colectomy. (C) 2017 Elsevier Inc. All rights reserved.