Minimally invasive ileal pouch-anal anastomosis for patients with obesity: a propensity score-matched analysis.

Details

Serval ID
serval:BIB_D10D6D8085E9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Minimally invasive ileal pouch-anal anastomosis for patients with obesity: a propensity score-matched analysis.
Journal
Langenbeck's archives of surgery
Author(s)
Abd El Aziz M.A., Calini G., Grass F., Behm K.T., D' Angelo A.L., Shawki S., Mathis K.L., Larson D.W.
ISSN
1435-2451 (Electronic)
ISSN-L
1435-2443
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Obesity is a risk factor for failure of pouch surgery completion. However, little is known about the impact of obesity on short-term outcomes after minimally invasive (MIS) ileal pouch-anal anastomosis (IPAA). This study aimed to assess short-term postoperative outcomes in patients undergoing MIS total proctocolectomy (TPC) with IPAA in patients with and without obesity.
All adult patients (≥ 18 years old) who underwent MIS IPAA as reported in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files 2007 to 2018 were included. Patients were divided according to their body mass index (BMI) into two groups (BMI ≥ 30 kg/m <sup>2</sup> vs. BMI < 30 kg/m <sup>2</sup> ). Baseline demographics, preoperative risk factors including comorbidities, American Society of Anesthesiologists Class, smoking, different preoperative laboratory parameters, and operation time were compared between the two groups. Propensity score matching (1:1) based on logistic regression with a caliber distance of 0.2 of the standard deviation of the logit of the propensity score was used to overcome biases due to different distributions of the covariates. Thirty-day postoperative complications including overall surgical and medical complications, surgical site infection (SSI), organ space infection, systemic sepsis, 30-day mortality, and length of stay were compared between both groups.
Initially, a total of 2158 patients (402 (18.6%) obese and 1756 (81.4%) nonobese patients) were identified. After 1:1 matching, 402 patients remained in each group. Patients with obesity had a higher risk of postoperative organ/space infection (12.9%; vs. 6.5%; p-value 0.002) compared to nonobese patients. There was no difference between the groups regarding the risk of postoperative sepsis, septic shock, need for blood transfusion, wound disruption, superficial SSI, deep SSI, respiratory, renal, major adverse cardiovascular events (myocardial infarction, stroke, cardiac arrest requiring cardiopulmonary resuscitation), venous thromboembolism, 30-day mortality, and length of stay.
MIS IPAA can be safely performed in patients with obesity. However, patients with obesity have a 2-fold risk of organ space infection compared to patients without obesity. Loss of weight before MIS IPAA is recommended not only to allow for pouch creation but also to decrease organ space infections.
Keywords
Ileal pouch-anal anastomosis, Minimally invasive surgery, Surgical site infection, Ulcerative colitis
Pubmed
Web of science
Open Access
Yes
Create date
25/05/2021 13:59
Last modification date
28/10/2021 5:45
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