Risk Factors for Readmission Following Ileal Pouch-Anal Anastomosis: an American College of Surgeons National Surgical Quality Improvement Program Analysis

Background: The purpose of this study was to identify preventable reasons for readmission and to delineate risk factors for readmission in the perioperative period for patients with chronic ulcerative colitis undergoing ileal pouch-anal anastomosis (IPAA).

Methods: Patients with a diagnosis of chronic ulcerative colitis undergoing either total proctocolectomy with IPAA or proctectomy with IPAA were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012-2015. Unplanned 30-d readmissions were reviewed and categorized by reason for readmission. The unplanned readmission rate within 30 d was calculated by the person-days method. Multivariable Cox proportional hazard regression models determined independent risk factors for overall 30-d unplanned readmissions and readmissions sorted by primary readmission diagnosis.

Results: Three thousand four hundred one patients had an IPAA performed during the study period. The overall unplanned readmission rate was 32.9% per 30 person-days. Leading diagnoses for unplanned readmission included infectious complications, dehydration, and venous thromboembolism (VTE). Multivariable analysis found Hispanic white and black/African American race/ethnicity (both versus non-Hispanic white) to be independently associated with unplanned 30-d readmission. Obesity, operative time 330+ min (versus <189 min), and Hispanic white race/ethnicity (versus non-Hispanic white) were associated with readmission for infectious complications. Age 57+ y (versus age 18-32 y) and hypertension requiring medication were associated with readmission for dehydration. Total proctocolectomy with IPAA (versus proctectomy with IPAA) was associated with readmission for VTE.

Conclusions: One-third of patients undergoing IPAA experience an unplanned 30-d readmission. Infectious complications and dehydration account for most of the unplanned readmissions. Outpatient pathways to prevent dehydration and the use of extended VTE prophylaxis after two-stage IPAA may help reduce the rates of readmission following IPAA.