Conditional Survival After Ipaa For Ulcerative And Indeterminate Colitis Does Long-Term Pouch Survival Improve Or Worsen With Time?

BACKGROUND:Risk factors for pouch survival may or may not have a linear relationship with pouch loss over time. Conditional survival is a method to describe these nonlinear time-to-event relationships by reporting the expected survival at various time points.OBJECTIVE:The aim of this study was to calculate conditional pouch survival based on occurrence of risk factors for pouch loss.DESIGN:This was a retrospective study from an institutional database.SETTINGS:The study was conducted at the Cleveland Clinic Foundation.PATIENTS:Patients with ulcerative or indeterminate colitis who underwent index IPAA construction between 1986 and 2016 were included.MAIN OUTCOME MEASURES:Patients were stratified based on postoperative anastomotic leak, abscess, or fistula occurrence. The Kaplan-Meier method with conditional survival was used to estimate overall and cause-specific survival at 10 years.RESULTS:A total of 3468 patients underwent IPAA during the study period. The overall 10-year pouch survival rate was 0.94 (95% CI, 0.93-0.95), and after 1 year the conditional pouch survival increased to 0.95 (95% CI, 0.94-0.96), after 3 years to 0.97 (95% CI, 0.96-0.98), and after 5 years to 0.98 (95% CI, 0.98-0.99). A total of 122 patients (3.5%) developed anastomotic leak, and the 10-year IPAA survival in patients with leak was 0.85 (95% CI, 0.77-0.93). In this group, after 1 year of pouch survival, the conditional pouch survival increased to 0.89 (95% CI, 0.82-0.96) and after 3 years to 0.98 (95% CI, 0.94-1.00). A similar pattern was seen for IPAA with postoperative abscess. The conditional survival curve was stable over time for patients with a fistula.LIMITATIONS:This was a retrospective, single-institution study.CONCLUSIONS:Overall conditional pouch survival improved over time for patients with postoperative anastomotic leak and abscess. These novel findings can be useful to counsel patients regarding expectations for long-term pouch survival even if they develop leaks and abscesses. See Video Abstract at http://links.lww.com/DCR/B217.