Temporal trends in ileoanal pouch surgery for paediatric onset ulcerative colitis in England from 1997 to 2015 using hospital episode statistics
Temporal trends in ileoanal pouch surgery for paediatric onset ulcerative colitis in England from 1997 to 2015 using hospital episode statistics
Introduction: Ileal pouch-anal anastomosis (IPAA) following colectomy for ulcerative colitis (UC) achieves restoration of intestinal continuity with potential return of continence. It is undertaken relatively infrequently in children. We aimed to investigate the national frequency of IPAA in paediatric UC and report outcomes useful for surgeon/centre benchmarking. Methods: Hospital Episode Statistics data were obtained for all admissions in England (1997–2015) in children (< 18 years) who underwent IPAA for UC using OPCS-4 procedural codes. Surgeon specialty, readmission, and reoperation rates were identified. Data are median (interquartile range). Results: UC was diagnosed in 7604 children in whom 346 (4.6%) underwent IPAA at age 15 [13–17] years. Laparoscopy was used in 55 (15.9%) cases and in the most recent 10 years more commonly by specialist paediatric surgeons (SPS) than general surgeons (GS) (34.3%vs14.7%, p = 0.001). National frequency of IPAA ranged from 12 to 34 annually. Where specialty was available, 95/342 (57%) cases were undertaken by GS and 147/342 (43%) cases by SPS. The proportion of cases undertaken by SPS increased significantly compared to GS over the study period, p = 0.0003. Post-operative length of stay was 8 [6–11] days. During the index admission, unplanned return to theatre was required in 25/346 (7.2%). Following discharge 58 (16.8%) were readmitted within 30 days. Overall return to theatre rate within 30 days of pouch surgery was 11.0% (38/346). Conclusion: IPAA for UC within childhood is undertaken infrequently in England, with a shift towards SPS undertaking surgery. These data can be used by surgeons to benchmark outcomes. Level of Evidence: IV.
Colectomy, Colitis, Ileal pouch-anal anastomosis, Outcomes
Bethell, George
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Ashton, James
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Adams, Steve
48f34f33-162f-45c7-a03d-eba9a7512217
Johnson, Toby
9677b18b-90e1-4d64-8d3e-16a884b04e7c
Beattie, R Mark
9a66af0b-f81c-485c-b01d-519403f0038a
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Stanton, Michael P
0a528535-336c-4a48-ae38-f5b0577d2e14
Bethell, George
1415d0da-ca8d-4652-bffc-1b38e087cde3
Ashton, James
03369017-99b5-40ae-9a43-14c98516f37d
Adams, Steve
48f34f33-162f-45c7-a03d-eba9a7512217
Johnson, Toby
9677b18b-90e1-4d64-8d3e-16a884b04e7c
Beattie, R Mark
9a66af0b-f81c-485c-b01d-519403f0038a
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Stanton, Michael P
0a528535-336c-4a48-ae38-f5b0577d2e14
Bethell, George, Ashton, James, Adams, Steve, Johnson, Toby, Beattie, R Mark, Hall, Nigel and Stanton, Michael P
(2021)
Temporal trends in ileoanal pouch surgery for paediatric onset ulcerative colitis in England from 1997 to 2015 using hospital episode statistics.
Journal of Pediatric Surgery.
(doi:10.1016/j.jpedsurg.2021.10.027).
Abstract
Introduction: Ileal pouch-anal anastomosis (IPAA) following colectomy for ulcerative colitis (UC) achieves restoration of intestinal continuity with potential return of continence. It is undertaken relatively infrequently in children. We aimed to investigate the national frequency of IPAA in paediatric UC and report outcomes useful for surgeon/centre benchmarking. Methods: Hospital Episode Statistics data were obtained for all admissions in England (1997–2015) in children (< 18 years) who underwent IPAA for UC using OPCS-4 procedural codes. Surgeon specialty, readmission, and reoperation rates were identified. Data are median (interquartile range). Results: UC was diagnosed in 7604 children in whom 346 (4.6%) underwent IPAA at age 15 [13–17] years. Laparoscopy was used in 55 (15.9%) cases and in the most recent 10 years more commonly by specialist paediatric surgeons (SPS) than general surgeons (GS) (34.3%vs14.7%, p = 0.001). National frequency of IPAA ranged from 12 to 34 annually. Where specialty was available, 95/342 (57%) cases were undertaken by GS and 147/342 (43%) cases by SPS. The proportion of cases undertaken by SPS increased significantly compared to GS over the study period, p = 0.0003. Post-operative length of stay was 8 [6–11] days. During the index admission, unplanned return to theatre was required in 25/346 (7.2%). Following discharge 58 (16.8%) were readmitted within 30 days. Overall return to theatre rate within 30 days of pouch surgery was 11.0% (38/346). Conclusion: IPAA for UC within childhood is undertaken infrequently in England, with a shift towards SPS undertaking surgery. These data can be used by surgeons to benchmark outcomes. Level of Evidence: IV.
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Accepted/In Press date: 9 September 2021
e-pub ahead of print date: 29 October 2021
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Funding Information:
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. George Bethell is funded by the National Institute of Heath Research Academic Clinical Fellow programme. JJA is funded by an ESPEN personal fellowship and by an ESPR post-doctoral grant.
Publisher Copyright:
© 2021
Keywords:
Colectomy, Colitis, Ileal pouch-anal anastomosis, Outcomes
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Local EPrints ID: 451519
URI: http://eprints.soton.ac.uk/id/eprint/451519
ISSN: 0022-3468
PURE UUID: fd0328d8-5ee1-4113-8a0a-3ced2b2978ec
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Date deposited: 05 Oct 2021 16:32
Last modified: 17 Mar 2024 06:50
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Author:
George Bethell
Author:
Steve Adams
Author:
Toby Johnson
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R Mark Beattie
Author:
Michael P Stanton
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