Ileoanal pouch revision and excision surgery in a newly established pouch center. Requirements and costs for service provision

Abstract

Background: Complications of ileoanal pouch surgery affecting function and quality of life may require surgical correction or pouch excision. The management of patients with pouch dysfunction requires a multidisciplinary approach and demand for service provisions include multiple healthcare professionals and resources. The aim of this study is to present the service requirements, surgical outcomes for redo pouch surgery and pouch excision, with cost-analysis of the required resources. Methods: All patients undergoing surgery for revision or excision of the ileoanal pouch from June 2021 to May 2023 were prospectively included. Patient undergoing only diagnostic procedures, or perineal procedures were excluded. Outcomes within 30-days of surgery were collected, including readmissions and re-operations. Cost analysis of all investigations, outpatient appointments and procedures prior to pouch revision or pouch excision was conducted. Results: Twenty patients were included during the 24 months study period: 13 underwent abdominal revisional pouch surgery, 7 had ileoanal pouch excision. 15 patients (75%) were tertiary referrals from other hospitals in the UK. The median interval between index IPAA surgery and revision was 113 months. 3 multidisciplinary clinical appointments, 2 imaging modalities, and at least one invasive day-surgery procedure were required for each patient prior to surgery. Four patients (20%) developed Clavien-Dindo 3 or higher complications. Conclusions: We estimated a starting cost of £22.605 ($29.589) for provision of pouch revision or excision surgery for investigations and treatments from referral to the pouch unit to surgery. Expertise and infrastructure are needed for indication and peri-operative management of these uncommonly performed surgical procedures.