Analysis of preoperative predictors for pouchitis after surgery for ulcerative colitis: A multicentre retrospective study of the clinical outcome of surgery for ulcerative colitis in Japan (COSUC study).

Abstract

Pouchitis is a prevalent complication following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and significantly impacts patient outcomes. The identification of risk factors and development of predictive models would help to guide perioperative management. This multicentre retrospective study analysed data from 1136 UC patients who underwent IPAA between 2005 and 2019 as part of the Clinical Outcome of Surgery for Ulcerative Colitis (COSUC) study. Potential risk factors, including demographic, clinical and surgical variables, were assessed using univariable and multivariable logistic regression. A predictive model was developed and validated using separate cohorts, with performance evaluated via receiver operating characteristic (ROC) curve analysis. Pouchitis occurred in 67 patients (5.9%). Univariable analysis identified younger age (<40 years), lower body mass index (BMI) and preoperative use of steroids and immunosuppressants as significant risk factors. Multivariable analysis confirmed preoperative steroid use as the only independent predictor (HR 1.98, p = 0.016). The predictive model achieved an area under the curve (AUC) of 0.63 in the training cohort and 0.67 in the validation cohort. Using a 9.6% probability cut-off, the model demonstrated moderate sensitivity and high specificity in identifying high-risk patients. Preoperative corticosteroid use was identified as the only independent risk factor for pouchitis after IPAA in UC patients. A risk model incorporating age, BMI and immunosuppressive therapy was developed and may aid in perioperative risk stratification. However, given the study's retrospective design and limited variable scope, further validation in prospective cohorts is necessary to confirm its clinical utility.