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IPAA surgery safe in older IBD patients
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ORLANDO, Fla. — Patients with inflammatory bowel disease aged older than 50 years showed similar outcomes as younger patients after ileal pouch anal anastomosis surgery, according to a poster presentation at AIBD 2017.
Based on these findings, Amy L. Lightner, MD, and surgical colleagues from the Mayo Clinic concluded that IPAA surgery “should continue to be offered to patients over the age of 50 without fear of an increased risk of compromised pouch function or pouch failure.”
While between 10% to 15% of patients with IBD are diagnosed after age 60, and current guidelines do not indicate age as a reason to avoid IPAA, some surgeons are hesitant to perform IPAA in patients older than age 50 years “due to substantial short-term morbidity,” and medical literature on long-term outcomes in this age group is limited, Lightner and colleagues wrote in their study abstract.
Therefore, they reviewed data on 911 patients who underwent two- or three-stage IPAA from 2002 to 2013, and compared outcomes between patient aged older and younger than age 50 at the time of IPAA construction.
They found that operative characteristics and short-term complications were comparable between the two age groups. Specifically, they observed no differences in the rates of urinary tract infection, pneumonia, partial small bowel obstruction/ileus, venous thromboembolism, or intensive care unit admission. However, pelvic sepsis and urinary retention rates were higher in the older patients (P < .05 for both)
In terms of pouch function, the investigators found some short-term differences in older patients, including more frequent daytime incontinence (60% vs. 37%; P < .01), daytime pad use (34% vs. 11%; P < .01) and nighttime pad use (37% vs. 22%; P = .04) at 6 months to a year and a half. Nighttime pad use was also higher in older patients from 4 to 6 years (39% vs. 20%; P < .01). However, the researchers said these differences were “limited” and resolved over time. Pouch failure rates were comparable (14% vs. 8%).
Finally, quality of life was comparable across age groups through 6 years of follow-up. – by Adam Leitenberger
Reference:
McKenna NP, et al. Abstract P-017. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.
Disclosures: The study authors report no relevant financial disclosures.