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

William Y Luo; Stefan D Holubar; Liliana Bordeianou; Bard C Cosman; Roxanne Hyke; Edward C Lee; Evangelos Messaris; Julia Saraidaridis; Jeffrey S Scow; Virginia O Shaffer; Radhika Smith; Randolph M Steinhagen; Florin Vaida; Samuel Eisenstein; National Surgical Quality Improvement Program-Inflammatory Bowel Disease (NSQIP-IBD) Collaborative: Collaborating Institutions and Investigators

doi:10.1016/j.amjsurg.2020.05.035

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

Am J Surg. 2021 Jan;221(1):174-182. doi: 10.1016/j.amjsurg.2020.05.035. Epub 2020 Jun 12.

Authors

William Y Luo¹, Stefan D Holubar², Liliana Bordeianou³, Bard C Cosman⁴, Roxanne Hyke⁵, Edward C Lee⁶, Evangelos Messaris⁷, Julia Saraidaridis⁸, Jeffrey S Scow⁹, Virginia O Shaffer¹⁰, Radhika Smith¹¹, Randolph M Steinhagen¹², Florin Vaida¹³, Samuel Eisenstein¹⁴; National Surgical Quality Improvement Program-Inflammatory Bowel Disease (NSQIP-IBD) Collaborative: Collaborating Institutions and Investigators

Collaborators

National Surgical Quality Improvement Program-Inflammatory Bowel Disease (NSQIP-IBD) Collaborative: Collaborating Institutions and Investigators:
Samuel Eisenstein¹⁵, Sonia Ramamoorthy¹⁵, Nicholas Hilbert¹⁵, Randolph Steinhagen¹⁶, Patricia Sylla¹⁶, Celia Divino¹⁶, Reba Miller¹⁶, Michael Deutsch¹⁷, Jeffery Scow¹⁷, Pamela Huggins¹⁷, Benjamin Shogan¹⁸, Neil Hyman¹⁸, Vivek Prachand¹⁸, Sue Sullivan¹⁸, Tracey Hull¹⁹, Stefan Holubar¹⁹, Xue Jia¹⁹, Nancy Anzlovar¹⁹, Susan Bohne¹⁹, Edward Lee²⁰, Brian Valerian²⁰, Megan Keenan²⁰, Andrea Goyette²⁰, David Spain²¹, Roxanne Hyke²¹, Elmer De Leon²¹, Julia Saraidaridis²², William David Lewis²², Terry Golden²², Lynne Crawford²², Matthew Mutch²³, Radhika Smith²³, Bruce Hall²³, Mitzi Hirbe²³, Joann Batten²³, Rocco Riccardi²⁴, Liliana Bordeianou²⁴, Hiroko Kunitake²⁴, Donna Antonelli²⁴, Kathy Swierzewski²⁴, Lynn Devaney²⁴, Evangelos Messaris²⁵, Richard Whyte²⁵, Mary Ward²⁵, Mary Beth Cotter²⁵, Virginia Shaffer²⁶, Joe Sharma²⁶, Judy Lewis²⁶, Shamsah Sitafalwalla²⁶, Muneera Kapadia²⁷, Timothy Kresowik²⁷, Mary Belding-Schmitt²⁷, Alessandro Fichera²⁸, Debbie Aguilar²⁸, Martha Mueller²⁸

Affiliations

¹ University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: wyluo@health.ucsd.edu.
² Department of Colon & Rectal Surgery, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH, 44195, USA. Electronic address: holubas@ccf.org.
³ Colorectal Surgery Program, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114-3117, USA. Electronic address: lbordeianou@mgh.harvard.edu.
⁴ University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Surgery, Veteran Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA. Electronic address: bard.cosman@va.gov.
⁵ Stanford Health Care, 500 Pasteur Dr, Palo Alto, CA, 94304, USA. Electronic address: RHyke@stanfordhealthcare.org.
⁶ Division of General Surgery, Albany Medical Center, 50 New Scotland Avenue MC-193, 5th Floor, Albany, NY, 12208, USA. Electronic address: leee@amc.edu.
⁷ Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro Building, 3rd Floor, Boston, MA, 02215-5400, USA. Electronic address: emessari@bidmc.harvard.edu.
⁸ Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road Burlington, MA, 01805, USA. Electronic address: julia.t.saraidaridis@lahey.org.
⁹ Department of Surgery, Penn State Health, 200 Campus Dr, Suite 3100 | Entrance 4, Hershey, PA, 17033, USA. Electronic address: jscow@pennstatehealth.psu.edu.
¹⁰ Department of Surgery, Emory University School of Medicine, Room B206, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA. Electronic address: virginia.o.shaffer@emory.edu.
¹¹ Department of Surgery, Washington University School of Medicine in St. Louis, 5201 Midamerica Plaza, St. Louis, MO, 63141, USA. Electronic address: radhikasmith@wustl.edu.
¹² Department of Surgery, The Mount Sinai Hospital, 5 East 98th Street, 14th Floor, Suite D, Box 1259, New York, NY, 10029, USA. Electronic address: randolph.steinhagen@mountsinai.org.
¹³ University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: fvaida@health.ucsd.edu.
¹⁴ University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: seisenstein@health.ucsd.edu.
¹⁵ University of California, San Diego, USA.
¹⁶ Mount Sinai Hospital, USA.
¹⁷ Penn State Milton S. Hershey Medical Center, USA.
¹⁸ University of Chicago, USA.
¹⁹ Cleveland Clinic, USA.
²⁰ Albany Medical Center, USA.
²¹ Stanford University, USA.
²² Beth Israel Lahey Health, USA.
²³ Washington University, USA.
²⁴ Massachusetts General Hospital, USA.
²⁵ Beth Israel Deaconness, USA.
²⁶ Emory University, USA.
²⁷ University of Iowa, USA.
²⁸ Baylor University, USA.

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.

Keywords: Inflammatory bowel disease; NSQIP; Outcomes; Restorative proctocolectomy; Ulcerative colitis.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Aged
Colitis, Ulcerative / surgery*
Female
General Surgery / standards
Humans
Male
Medical Audit
Middle Aged
Postoperative Complications / epidemiology
Postoperative Complications / prevention & control
Proctocolectomy, Restorative* / standards
Quality Improvement
Registries
Retrospective Studies
Time Factors
United States
Young Adult

Grants and funding

TL1 TR001443/TR/NCATS NIH HHS/United States