Abstract：
BACKGROUND: Ileal pouch-anal anastomosis (\'pouch surgery\') provides a chance to avoid permanent ileostomy after proctocolectomy, but can be associated with poor outcomes. The relationship between hospital-level/surgeon factors (including volume) and outcomes after pouch surgery is of increasing interest given arguments for increasing centralization of these complex procedures. The aim of this systematic review was to appraise the literature describing the influence of hospital-level and surgeon factors on outcomes after pouch surgery for inflammatory bowel disease.
METHODS: A systematic review was performed of studies reporting outcomes after pouch surgery for inflammatory bowel disease. The MEDLINE (Ovid), Embase (Ovid), and Cochrane CENTRAL databases were searched (1978-2022). Data on outcomes, including mortality, morbidity, readmission, operative approach, reconstruction, postoperative parameters, and pouch-specific outcomes (failure), were extracted. Associations between hospital-level/surgeon factors and these outcomes were summarized. This systematic review was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42022352851).
RESULTS: A total of 29 studies, describing 41 344 patients who underwent a pouch procedure, were included; 3 studies demonstrated higher rates of pouch failure in lower-volume centres, 4 studies demonstrated higher reconstruction rates in higher-volume centres, 2 studies reported an inverse association between annual hospital pouch volume and readmission rates, and 4 studies reported a significant association between complication rates and surgeon experience.
CONCLUSIONS: This review summarizes the growing body of evidence that supports centralization of pouch surgery to specialist high-volume inflammatory bowel disease units. Centralization of this technically demanding surgery that requires dedicated perioperative medical and nursing support should facilitate improved patient outcomes and help train the next generation of pouch surgeons.
METHODS: A systematic review was performed of studies reporting outcomes after pouch surgery for inflammatory bowel disease. The MEDLINE (Ovid), Embase (Ovid), and Cochrane CENTRAL databases were searched (1978-2022). Data on outcomes, including mortality, morbidity, readmission, operative approach, reconstruction, postoperative parameters, and pouch-specific outcomes (failure), were extracted. Associations between hospital-level/surgeon factors and these outcomes were summarized. This systematic review was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42022352851).
RESULTS: A total of 29 studies, describing 41 344 patients who underwent a pouch procedure, were included; 3 studies demonstrated higher rates of pouch failure in lower-volume centres, 4 studies demonstrated higher reconstruction rates in higher-volume centres, 2 studies reported an inverse association between annual hospital pouch volume and readmission rates, and 4 studies reported a significant association between complication rates and surgeon experience.
CONCLUSIONS: This review summarizes the growing body of evidence that supports centralization of pouch surgery to specialist high-volume inflammatory bowel disease units. Centralization of this technically demanding surgery that requires dedicated perioperative medical and nursing support should facilitate improved patient outcomes and help train the next generation of pouch surgeons.
摘要：
背景：回肠袋-肛门吻合术（“袋手术”）提供了避免直肠结肠切除术后永久性回肠造口术的机会，但可能与不良结果有关。考虑到增加这些复杂程序的集中化，医院/外科医生因素（包括体积）与囊袋手术后结果之间的关系越来越受到关注。本系统综述的目的是评估描述医院水平和外科医生因素对炎症性肠病袋式手术后结果的影响的文献。
方法：对炎症性肠病囊袋手术后转归的研究进行了系统评价。MEDLINE(Ovid),Embase(Ovid),和CochraneCENTRAL数据库进行了搜索（1978-2022）。关于成果的数据，包括死亡率,发病率，重新接纳,手术入路,重建,术后参数,和小袋特定的结果(失败)，被提取。总结了医院/外科医生因素与这些结果之间的关联。这项系统评价在PROSPERO中进行了前瞻性注册，国际前瞻性系统评价注册（CRD42022352851）。
结果：共29项研究，描述了41344例接受囊手术的患者，包括在内；3项研究表明，在容量较低的中心，囊袋故障率较高，4项研究表明，在体积较大的中心，重建率较高，2项研究报告了年度医院邮袋体积与再入院率之间的负相关关系，4项研究报告了并发症发生率和外科医生经验之间的显著关联.
结论：这篇综述总结了越来越多的证据支持将囊袋手术集中到专科高容量炎症性肠病单位。这种需要专门的围手术期医疗和护理支持的技术要求的手术的集中化应有助于改善患者的预后，并有助于培训下一代的眼袋外科医生。
方法：对炎症性肠病囊袋手术后转归的研究进行了系统评价。MEDLINE(Ovid),Embase(Ovid),和CochraneCENTRAL数据库进行了搜索（1978-2022）。关于成果的数据，包括死亡率,发病率，重新接纳,手术入路,重建,术后参数,和小袋特定的结果(失败)，被提取。总结了医院/外科医生因素与这些结果之间的关联。这项系统评价在PROSPERO中进行了前瞻性注册，国际前瞻性系统评价注册（CRD42022352851）。
结果：共29项研究，描述了41344例接受囊手术的患者，包括在内；3项研究表明，在容量较低的中心，囊袋故障率较高，4项研究表明，在体积较大的中心，重建率较高，2项研究报告了年度医院邮袋体积与再入院率之间的负相关关系，4项研究报告了并发症发生率和外科医生经验之间的显著关联.
结论：这篇综述总结了越来越多的证据支持将囊袋手术集中到专科高容量炎症性肠病单位。这种需要专门的围手术期医疗和护理支持的技术要求的手术的集中化应有助于改善患者的预后，并有助于培训下一代的眼袋外科医生。
