Does ethnicity impact the long-term outcome after restorative proctocolectomy with ileal pouch anal anastomosis?

Racial/ethnic disparities were reported to impact the phenotype of inflammatory bowel disease and its treatment. The impact of race/ethnicity on ileal pouch anal anastomosis (IPAA's) outcomes is unknown. Our aim was to investigate whether it impacts IPAA's outcomes.

A prospectively maintained IPAA database(1983-2022) was searched to identify patients with IPAA who had race/ethnicity data available regardless of diagnosis. The cohort was divided into 2 groups: Whites and Non-Whites. We analysed patients' demographics, postoperative complications, Kaplan-Meier pouch survival, function (stool number, seepage), quality of life (QoL) scores, social, dietary and sexual restrictions.

A total of 4954 patients were included, with 4674 whites and 280 non-whites. Non-Whites consisted of Black (123, 44%), Asians (23, 8.2%) and Hispanics (134, 48%). The groups were comparable in terms of age, gender and pathological diagnosis (p = 0.16). The rate of long-term anastomotic leaks, pelvic sepsis and strictures was not significantly different between groups. There was a higher rate of pouchitis in White (29%) vs. Non-White (18%) (p < 0.001); fistula [White (8%) vs. Non-White (4.5%) (p = 0.04)] and postoperative obstruction [White (13%) vs. Non-White (9%) (p = 0.04)]. The Kaplan-Meier pouch retention was similar (97% at 5 years, 96% at 10 years and 95% at 15 years) in White and Non-White patients. The average QoL scores were comparable between Non-White (7.7 ± 2.5) and White (7.9 ± 2.4) (p = 0.34). Non-Whites had more social restrictions (25%) vs. Whites (15%) (p = 0.04).

In a large IPAA cohort, more White patients had pouchitis compared to Non-White patients. Social restrictions were more prevalent in Non-White patients compared to those in White patients over the long term. More research is needed to understand how race/ethnicity impacts the IPAA outcomes.