Abstract | HYPOTHESIS: DESIGN: Logistic regression analysis was used to identify independent factors favoring omission of ileostomy at the time of RPC. A propensity nomogram was developed and validated using measures of calibration, discrimination, and subgroup analysis. SETTING: Two tertiary referral centers. PATIENTS: A total of 4013 patients undergoing RPC between January 1977 and December 2005 were included in the study sample. MAIN OUTCOME MEASURE: RESULTS: After study group exclusions, proximal diversion was performed in 3196 of 3733 patients (85.6%) undergoing RPC; 45.4% of 3733 patients were women. The mean (SD) age at surgery was 37.4 (12.8) years. Ulcerative colitis was the indication for RPC in 2304 patients (61.7%) and familial adenomatous polyposis in 364 patients (9.8%), and a J pouch was performed in 2657 patients (71.2%). The following were found to be associated with ileostomy omission: stapled anastomosis (odds ratio [OR], 6.4), no preoperative corticosteroid use (OR, 3.2), familial adenomatous polyposis diagnosis (OR, 2.6), cancer diagnosis (OR, 3.4), female sex (OR, 1.6), and age at surgery younger than 26 years (OR, 2.1) (P < .01 for all). The model discriminated well (area under the receiver operating characteristic curve, 74.9%), with no significant differences between observed and expected outcomes (P = .49). Omission of proximal diversion demonstrated no significant effect on postoperative adverse events, although it was associated with a 2-day increase in the median length of hospital stay (P < .01). CONCLUSION: Incorporation of a 5-point nomogram in the preoperative assessment of patients undergoing RPC may aid clinicians in identifying a select group of patients who may be candidates for ileostomy omission during RPC.
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Authors | Richard E Lovegrove, Henry S Tilney, Feza H Remzi, R John Nicholls, Victor W Fazio, Paris P Tekkis |
Journal | Archives of surgery (Chicago, Ill. : 1960)
(Arch Surg)
Vol. 146
Issue 1
Pg. 82-8
(Jan 2011)
ISSN: 1538-3644 [Electronic] United States |
PMID | 21242450
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adenomatous Polyposis Coli
(surgery)
- Adult
- Colitis, Ulcerative
(surgery)
- Colonic Pouches
(adverse effects)
- Female
- Humans
- Ileostomy
(adverse effects)
- Male
- Middle Aged
- Multivariate Analysis
- Nomograms
- Patient Selection
- Proctocolectomy, Restorative
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