I was in worse shape than expected. I was an elective surgery due to low grade dysplasia and was asked to lose 10 pounds for surgery. In the several months it took me to do that and then get a surgical appointment I deteriorated. When my colon was removed in surgery #1 my surgeon advised it was dissolving in his hands from the inflammation. I would have had toxic megacolon probably within weeks had I not proceeded.
For me 3 months exactly between step 1 and step 2. They do a pouchogram to make sure it doesn’t leak and you can’t have the second surgery until you pass the test so it’s not an arbitrary decision as your question implies. You either pass the pouchogram or you wait, it’s that simple. I passed first shot.