{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T01:40:15Z","timestamp":1745458815037,"version":"3.37.3"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,12,27]],"date-time":"2019-12-27T00:00:00Z","timestamp":1577404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32DK083256"],"award-info":[{"award-number":["T32DK083256"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,20]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ileal pouch\u2013anal anastomosis (IPAA) is the mainstay of surgical treatment for patients with ulcerative colitis (UC) but is associated with an increased risk of infertility. We developed a simulation model examining the impact of initial surgical procedure on quality-adjusted life-years (QALYs) and fertility end points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A patient-level state transition model was used to analyze outcomes by surgical approach strategy for females of childbearing age. Initial surgical options included IPAA, rectal-sparing colectomy with end ileostomy (RCEI), and ileorectal anastomosis (IRA). The primary outcome examined was QALYs, whereas secondary outcomes included UC and fertility-associated end points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>IPAA resulted in higher QALYs for patients aged 20\u201330 years, as compared with RCEI. For patients aged 35 years, RCEI resulted in higher QALYs (7.54 RCEI vs 7.53 IPAA) and was associated with a 28% higher rate of childbirth, a 14-month decrease in time to childbirth, and a 77% reduction in in vitro fertilization utilization. When accounting for the decreased infertility risk associated with laparoscopic IPAA, IPAA resulted in higher QALYs (7.57) even for patients aged 35 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite an increased risk of infertility, our model results suggest that IPAA may be the optimal surgical strategy for female UC patients aged 20\u201330 years who desire children. For patients aged 35 years, RCEI should additionally be considered, as QALYs for RCEI and IPAA were similar. These quantitative data can be used by patients and providers to help develop an individualized approach to surgical management choice.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ibd\/izz307","type":"journal-article","created":{"date-parts":[[2019,12,27]],"date-time":"2019-12-27T13:57:43Z","timestamp":1577455063000},"page":"1368-1376","source":"Crossref","is-referenced-by-count":7,"title":["Fertility Impact of Initial Operation Type for Female Ulcerative Colitis Patients"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1571-5856","authenticated-orcid":false,"given":"Adam S","family":"Faye","sequence":"first","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Oh","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay D","family":"Kumble","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi P","family":"Kiran","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, New York Presbyterian Columbia University Medical Center, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garrett","family":"Lawlor","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Medicine, New York, New York, 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