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

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.

Conventional Frailty Index Does Not Predict Risk of Postoperative Complications in Patients With IBD: A Multicenter Cohort Study

“…This study was conducted using data collected by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)-IBD collaborative, which was organized to improve data collection on IBD-specific outcomes via the overall ACS-NSQIP registry. 18,19 ACS-NSQIP is a nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care. We hypothesized that a risk index–based frailty assessment based on chronic diseases may not accurately predict the risk of postoperative complications in patients with IBD.…”

State-of-the-art surgery for ulcerative colitis

“…At high-volume centers, the majority of surgery in the elective setting is currently being performed using a minimally invasive approach [44]. There are many who advocate for laparoscopic or robotic approaches to these procedures, and much has been written on the advantages of a minimally invasive approach including less intraoperative blood loss, decreased LOS, faster return of bowel function, and improved 30-day outcomes [45][46][47].…”

“…As a result, the majority of IPAAs are currently created with a protective loop ileostomy. A recent analysis of high-volume IBD centers in the US showed that only 5.5% of IPAAs were undiverted [44].…”

“…One-stage procedures are rarely done; there may be a role for this procedure in healthier patients, for example, patients undergoing their procedures for dysplasia instead of medically refractory disease. In reality, these procedures are predominantly being performed via a classical 2-stage approach [44]. Postoperative management of these patients can be complex as most will leave a rectal tube (RT) for an extended time to help minimize the back pressure of the anal sphincters on the anastomosis.…”

National Databases for Assessment of Quality

“…4 A similar NSQIP initiative is underway for operations performed for inflammatory bowel disease. 19 20…”