Does the age of ulcerative colitis diagnosis impact outcomes of restorative proctocolectomy?

Ulcerative colitis (UC) can be diagnosed at a variety of different ages. We evaluated if age of ulcerative colitis (UC) diagnosis impacts outcomes of restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA).

A prospectively maintained pouch database (1983-2020) was queried to identify patients undergoing an RP for UC. The cohort was stratified based on bimodal disease presentation into 2 groups: the early adulthood group (19-30 years old) and the mid/late adulthood group (40-70 years old). Patients' demographics, postoperative complications, functional (stool number, seepage), and quality of life (QoL) rates were compared between the groups.

A total of 628 patients with an age range of 19-30 years old (18.1 ± 2.2 at the time of diagnosis, 24.2 ± 10.5 at the time of IPAA) and 706 patients with an age range of 40-70 years old (45 ± 3.0 at time of diagnosis, 52.3 ± 9.4 at time of IPAA) were identified. Older patients had longer disease duration, higher BMI, lower biologic use, and greater one-/two-staged IPAA, with 20% hand sewn anastomosis and 16.5% of S pouch configuration compared to younger ones. No difference was observed in anastomotic separation, pelvic sepsis, fistulas, or pouch failure in follow-up. Postoperatively, older patients more frequently developed bowel obstructions, strictures, and pouchitis, in addition to higher rates of seepage (p < 0.05). QoL was comparable between groups.

While IPAA retention rates are comparable between different age cohorts, older age at diagnosis and IPAA construction is associated with higher rates of pouchitis, bowel obstruction, anastomotic strictures, and worse functional outcome. Quality of life is similar in those who retain their ileal pouch on the long-term.