Chance of pouch surgery after colectomy for ulcerative colitis based on pelvic pouch volumes at the colectomy hospital, a Swedish national cohort study.

Abstract

There are three reconstructive options after colectomy for ulcerative colitis (UC), ileal pouch anal anastomosis, ileorectal anastomosis and continent ileostomy. Less than 50% of UC patients in Sweden get bowel continuity after colectomy. The aim was to investigate the correlation between reconstructive volumes of the hospital performing the colectomy and the likelihood of reconstruction. From the Swedish National Patient Register, all ulcerative colitis patients subjected to colectomy between 1997 and 2020 were identified, and patient demographics, surgeries and hospital reconstructive volumes were extracted. Cox regression models of time from colectomy to reconstruction were performed, including age, sex, calendar time of colectomy, time from diagnosis, primary sclerosing cholangitis and pelvic pouch volume in the models. The patients were divided into groups depending on the annual number of pelvic pouches performed at the hospital performing the colectomy: 0, 1-3, 4-7, >7. Colectomy was performed in 4112 patients, 1932 (47%) patients were reconstructed. Restorative surgery was more common in high-volume versus low-volume units (62% vs. 38%). Ileorectal anastomosis was slightly more common than pelvic pouch (964 (50%) vs. 927 (48%)), but in high-volume units only 30% of the reconstructed patients received an ileorectal anastomosis. The chance of pelvic pouch increased with each volume category (HR: 1; 1.49; 1.79; 2.22 (p < 0.001)). The likelihood of receiving pouch surgery depends on the hospital where the colectomy was performed, which must be considered in the future organization of UC-surgery.