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Author Notes:

Samuel Eisenstein, MD FACS FASCRS, 3855 Health Sciences Drive #0987, La Jolla, CA 92093-0987, Phone: (858) 822-6277, Fax: (858) 228-1731. Email: seisenstein@health.ucsd.edu

WYL was supported by the National Institutes of Health TL1 Training Grant #1TL1TR001443. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Subject:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • Inflammatory bowel disease
  • Ulcerative colitis
  • NSQIP
  • Outcomes
  • Restorative proctocolectomy
  • OLMSTED COUNTY
  • CROHNS-DISEASE
  • PREVALENCE
  • MINNESOTA

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

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Journal Title:

AMERICAN JOURNAL OF SURGERY

Volume:

Volume 221, Number 1

Publisher:

, Pages 174-182

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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