EP442 - Comparative 30-day Outcomes of Different Stages RPC with IPAA in Patients with IBD: Insights from the 2017–2023 IBD-NSQIP Database

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Purpose/Background: Biologic agents have prompted a new era for patients with inflammatory bowel disease (IBD), in which more effective medical management greatly decreased the need for surgery. However, although fewer patients need surgery, those who do, tend to be sicker and older than in past decades. Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the preferred method to restore intestinal continuity in patients requiring IBD surgery. RPC can be performed as a 1-stage, 2-stage (1.RPC+diverting loop ileostomy (DLI), 2. DLI reversal), modified 2-stage (1. Total colectomy + ileostomy, 2. Completion proctectomy + IPAA), or 3-stage procedure (1. Total colectomy + ileostomy, 2. Completion proctectomy + IPAA + DLI, 3. DLI reversal). We aimed to compare the 30-day outcomes based on surgical approaches in patients with IBD.

Methods/Interventions: Patients aged 18-80 who underwent RPC for IBD were included using the 2017–2023 IBD-NSQIP database. Univariate analysis for categorical data was conducted using the Pearson χ² test or Fisher's exact test. The independent sample t-test and the Mann–Whitney U test were used for continuous variables. Frequencies and percentages were used to present categorical data and mean with standard deviations for continuous data. Any P value < 0.05 was considered statistically significant. We compared 30-day postoperative outcomes for patients with IBD who underwent 1-stage versus 2-stage RPC (Analysis 1), modified 2-stage versus 3-stage RPC (Analysis 2), and immediate (1-stage and 2-stage) versus delayed RPC (modified 2-stage and 3-stage).

Results/Outcomes: A total of 330 patients underwent RPC. Fifteen patients underwent 1-stage, 69 had 2-stage, 47 had modified 2-stage, and 199 had modified 3-stage RPC. Additionally, 84 patients underwent immediate RPC-IPAA, and 246 had delayed RPC-IPAA. In analysis 1, no significant differences were observed in 30-day outcomes between patients who underwent 1-stage versus 2-stage RPC-IPAA, including need for blood transfusion, hospital readmission, surgical site infection, sepsis, postoperative bleeding, length of stay, and operative time. In analysis 2, patients who underwent modified 2-stage RPC-IPAA experienced higher rates of renal complications (10.6% vs. 1.0%, p=0.003) and longer operative times (282.89 ± 118.48 minutes vs. 265.89 ± 99.98 minutes, p=0.023) compared to those who underwent 3-stage surgery. In analysis 3, no significant differences in cardiac complications, pulmonary complications, renal complications, blood transfusions, readmissions, venous thromboembolism, surgical site infection, non-home discharge, sepsis, postoperative bleeding, colectomy/proctectomy leaks, length of stay, and operative time were found between patients who underwent immediate versus delayed RPC-IPAA.

Conclusion/Discussion: The decision to perform a staged versus nonstaged RPC is not univocal and must take into account the indication for surgery, the characteristics of the patient, the risk of anastomotic leak, the patient’s overall capability to survive a symptomatic leak, and the surgeon’s experience and level of confidence.