CIGARETTE USE AND SURGICAL OUTCOMES IN ULCERATIVE COLITIS PATIENTS WITH ILEAL POUCH ANAL ANASTOMOSIS: A PROPENSITY-MATCHED COHORT STUDY

Abstract BACKGROUND Ulcerative colitis (UC) patients who undergo total proctocolectomy with ileal pouch–anal anastomosis (IPAA) may experience postoperative complications, including pouchitis, pouch-related morbidity, and infection. Smoking and nicotine exposure have been variably reported to influence disease activity and surgical outcomes. This study evaluated outcomes in UC/IPAA patients with and without cigarette exposure. METHODS A retrospective cohort analysis was performed using propensity score–matched cohorts. Two groups were identified: UC/IPAA patients without cigarette exposure (n = 151) and UC/IPAA patients with documented cigarette exposure (n = 151). Outcomes analyzed included pouchitis, pouch-related complications, Clostridioides difficile infection, and infertility. Risk differences, risk ratios, odds ratios (OR), and p-values were calculated. RESULTS The odds of pouchitis were similar between cigarette users and non-users (OR 1.12, 95% CI 0.70–1.78). Likewise, the odds of pouch complications (OR 1.12, 95% CI 0.71–1.77), other pouch complications (OR 0.82, 95% CI 0.41–1.67), and C. difficile infection (OR 1.11, 95% CI 0.46–2.69) showed no significant differences. However, infertility was significantly higher among cigarette users, with 10 cases compared to none in the non-smoking group (p = 0.001). CONCLUSION In this matched cohort of UC/IPAA patients, cigarette use was not associated with increased odds of pouchitis, pouch-related complications, or C. difficile infection. However, cigarette use was strongly associated with infertility, suggesting a potential adverse reproductive effect that warrants further investigation.