PURPOSE Ileal pouch-anal anastomosis (“pouch”) offers the patient a chance to avoid permanent ileostomy, but can be associated with poor outcome. The relationship between hospital level/surgeon factors (including volume) and outcomes following pouch surgery is of increasing interest, but a systematic review (SR) is lacking. This SR aimed to appraise the literature regarding the influence of hospital level and surgeon factors on outcomes following pouch surgery for IBD METHODOLOGY A SR was performed of studies reporting outcomes following pouch surgery for IBD. MEDLINE, EMBASE, and Cochrane CENTRAL were searched(1978-2022). Data on outcomes, including mortality, morbidity, readmission, operative approach, reconstruction, post operative parameters and pouch specific outcomes (failure), were extracted. The associations between hospital level/surgeon factors and these outcomes were summarised RESULTS A total of 29 studies, including 41,344 patients, were included. Three studies demonstrated higher rates of pouch failure in lower volume centres, four demonstrated higher reconstruction rates in higher volume centres, while two reported an inverse association between annual hospital pouch volume and readmission rates. However, the volume categories were heterogenous. Four studies reported a significant improvement in complication rates correlating with increased surgeon experience CONCLUSION This SR summarises the growing body of evidence that supports centralisation of pouch surgery to specialist high volume IBD units. Centralisation of this technically-demanding surgery that requires dedicated peri-operative medical and nursing support should facilitate improved patient outcomes and help train the next generation of pouch surgeons