Hospital costs and risk factors associated with complications of the ileal pouch anal anastomosis

Background: The purpose of this study was to estimate the costs associated with the most common complications of the ileal pouch anal anastomosis (IPAA) and identify factors that predispose to them. Methods: Hospital costs of 135 patients undergoing the IPAA were combined with information abstracted from charts. Logistic and linear regression modeling were used to estimate the marginal costs for the most common IPAA complications and determine factors predisposing to their occurrence. Results: The average overall cost for the IPAA was $20,865. Just more than half (53%) of patients experienced complications, the 3 most common being small-bowel obstruction (24.4%), pelvic/abdominal sepsis (6.7%), and dehydration (5.9%). The average cost to treat an episode of small-bowel obstruction was $6709. Treatment of pelvic/abdominal sepsis averaged $9268 per occurrence, whereas dehydration averaged $4860. Steroid use > 3 months before colectomy significantly increased the risk for any complication (P = .02). No factors were found to be good predictors of bowel obstruction. However, age > 42 years and low patient hematocrit were significant predictors of dehydration as a complication (P < .05). Trending toward significance were urgent operation and weight loss greater than 5%. Conclusions: The most common complications of the IPAA are small-bowel obstruction, pelvic/abdominal sepsis, and dehydration. Complications were responsible for approximately 44% of the overall cost of an IPAA. Factors that increase risk of IPAA complications are steroid use, low hematocrit, age > 42 years, nonelective procedures, and preoperative weight loss.