Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis

To assess mortality after restorative proctocolectomy (RPC) and determine the influencing factors with a specific focus on institutional caseload and surgical approach in France.

RPC is an uncommonly performed and demanding procedure; case volume may exert a significant influence on outcome.

Data of all patients who underwent RPC in France between 2009 and 2012, including demographics, diagnosis, procedures, mode of admission, discharge, and hospital type were collected.

One thousand one hundred sixty-six RPCs were performed in 237 centers (mean: 1.65 procedure/year/center). Rate of laparoscopic procedures was 47.1% (n = 549). Mortality reached 1.5% (n = 17). Independent factors for mortality were ageless than 45 years (odds ratio, OR = 3.9) and surgery in a center performing less than 3 RPC per year (OR = 3.2). Centers performing less than 3 RPC per year represented 89% of all centers, accounted for 37% (n = 431) of all patients and represented 70.6% of all deaths (n = 12). Underlying pathology exerted a significant effect on mortality; mortality rate after "classical" indications (polyposis and inflammatory bowel disease) was 0.7% (8/1078) and was 16.7% (9/54) for "nonclassical" indications (peritonitis, carcinomatosis, and so on) (P < 0.0001). Nonclassical diagnoses were observed more frequently in centers performing less than 3 RPC per year [40/412 (7.3%) vs 24/720 (3.3%), P = 0.0027]. A laparoscopic approach was associated with a low mortality rate on univariate analysis (0.7% vs 1.2%, P = 0.05), a shorter hospital stay (15.8 ± 0.6 vs 17.8 ± 0.55, P = 0.0053) and more frequently performed in experienced centers ≥3 RPC/year (50.8% vs 40.7%, P = 0.0009).

Mortality after RPC in centers performing 3 or less RPC per year was significantly higher, and accounted for more than half of all deaths. In France, consolidating all RPCs to higher volume centers may lead to better outcomes.