Association of Malnutrition with Postoperative Outcomes after Ileal Pouch-Anal Anastomosis
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RESEARCH COMMUNICATION
Association of Malnutrition with Postoperative Outcomes after Ileal Pouch-Anal Anastomosis Juliet June Ray 1 & Eren Esen 1 & Sarah McIntyre 1 & Hasan T. Kirat 1 & Michael Grieco 1 & Feza Remzi 1 Received: 13 July 2020 / Accepted: 31 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Morbidity . Inflammatory Bowel Disease . Ulcerative Colitis . Hypoalbuminemia . ACS-NSQIP
Introduction
Materials and Methods
Ileal pouch-anal anastomosis (IPAA) restores intestinal continuity after total proctocolectomy, and has become a standard of care for patients with ulcerative colitis (UC). Malabsorption, pain leading to poor enteral intake, steroid use, and chronic inflammation all contribute to poor nutrition in patients with UC.1 Although there is no gold standard for the assessment of nutrition in UC, serum albumin level, body mass index (BMI), and weight loss are commonly used, as they are convenient to study and reliably predictive.2 With its large and comprehensive dataset, the American Co llege of Su rg eon’s National Surgical Qu ality Improvement Program (ACS-NSQIP) provides an ideal sample. The aim of this study was to determine the relationship between preoperative nutritional status and postoperative complications after IPAA.
The study cohort was extracted from ACS-NSQIP. Patients with a diagnosis of Ulcerative Colitis (ICD-9: 556.x; ICD-10: K51) undergoing two-stage IPAA using CPT codes (44,157, 44,158, 44,211), and three-stage IPAA using CPT code (45,113), from 2005 to 2017 were selected. Patients < 18 years and those with missing variables of interest were excluded. Patient demographics, co-morbidities, and preoperative characteristics were assessed. Morbidity was defined by one or more of the complications after IPAA. Detailed variable definitions are available on the ACS-NSQIP website.3
* Juliet June Ray [email protected] Eren Esen [email protected]
Statistical Analyses Postoperative morbidity and length of stay (LOS) were compared across the three nutritional parameters of interest: hypoalbuminemia (< 3.5 g/dl), weight loss (> 10% in prior 6 months), and low BMI (< 18.5 kg/m2). Categorical variables were compared via the Fisher exact test or chi-square test; continuous variables were compared via independent t test or Mann-Whitney U test. Parameters with p < 0.05 on univariate analysis were included to separate logistic regressions to detect independent risk factors for postoperative morbidity, need for reoperation, and LOS above the median.
Sarah McIntyre [email protected] Hasan T. Kirat [email protected] Michael Grieco [email protected] Feza Remzi [email protected] 1
Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
Results We identified 5112 patients who underwent IPAA. After excluding those with missing malnutrition parameters, 3150 patients were studied. Demographics and clinical features are shown in Table 1. Univariate analysis indicated that hypoalbuminemia was signif
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