Better characterization of operation for ulcerative colitis through the National surgical quality improvement program: A 2-year audit of NSQIP-IBD

• Type of Material: Article
• Authors: Jyotirmay Sharma, Emory University; William Y Luo, University of California San Diego; Stefan D Holubar, Cleveland Clinic; Liliana Bordeianou, Massachusetts General Hospital; Bard C Cosman, University of California San Diego; Roxanne Hyke, Stanford Health Care; Edward C Lee, Albany Medical Center; Evangelos Messaris, Beth Israel Deaconess Medical Center; Julia Saraidaridis, Lahey Hospital and Medical Center; Jefferey S Scow, Penn State Health; Virginia Shaffer, Emory University; Radhika Smith, Washington University; Randolph M Steinhagen, The Mount Sinai Hospital; Florin Vaida, University of California San Diego; Samuel Eisenstein, University of California San Diego
• Language: English
• Date: 2021-01-01
• Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjsurg.2020.05.035
• Title of Journal or Parent Work: AMERICAN JOURNAL OF SURGERY
• Volume: 221
• Issue: 1
• Start Page: 174
• End Page: 182
• Keywords: OLMSTED COUNTY; CROHNS-DISEASE; Inflammatory bowel disease; Outcomes; MINNESOTA; Science & Technology; Ulcerative colitis; Surgery; NSQIP; PREVALENCE; Restorative proctocolectomy; Life Sciences & Biomedicine

Abstract

Introduction: There is little consensus of quality measurements for restorative proctocolectomy with ileal pouch-anal anastomosis(RPC-IPAA) performed for ulcerative colitis(UC). The National Surgical Quality Improvement Program(NSQIP) cannot accurately classify RPC-IPAA staged approaches. We formed an IBD-surgery registry that added IBD-specific variables to NSQIP to study these staged approaches in greater detail. Methods: We queried our validated database of IBD surgeries across 11 sites in the US from March 2017 to March 2019, containing general NSQIP and IBD-specific perioperative variables. We classified cases into delayed versus immediate pouch construction and looked for independent predictors of pouch delay and postoperative Clavien-Dindo complication severity. Results: 430 patients received index surgery or completed pouches. Among completed pouches, 46(28%) and 118(72%) were immediate and delayed pouches, respectively. Significant predictors for delayed pouch surgery included higher UC surgery volume(p = 0.01) and absence of colonic dysplasia(p = 0.04). Delayed pouch formation did not significantly predict complication severity. Conclusions: Our data allows improved classification of complex operations. Curating disease-specific variables allows for better analysis of predictors of delayed versus immediate pouch construction and postoperative complication severity. Short summary: We applied our previously validated novel NSIP-IBD database for classifying complex, multi-stage surgical approaches for UC to a degree that was not possible prior to our collaborative effort. From this, we describe predictive factors for delayed pouch formation in UC RPC-IPAA with the largest multicenter effort to date.