The ACS National Surgical Quality Improvement Program—Inflammatory Bowel Disease Collaborative: Design, Implementation, and Validation of a Disease-specific Module

Abstract

Background Surgery for inflammatory bowel disease (IBD) involves a complex interplay between disease, surgery, and medications, exposing patients to increased risk of postoperative complications. Surgical best practices have been largely based on single-institution results and meta-analyses, with multicenter clinical data lacking. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) has revolutionized the way in which large-volume surgical outcomes data have been collected. Our aim was to employ the ACS-NSQIP to collect disease-specific variables relevant to surgical outcomes in IBD. Study Design A collaborative of 13 high-volume IBD surgery centers was convened to collect 5 IBD-specific variables in NSQIP. Variables included biologic and immunomodulator medications usage, ileostomy utilization, ileal pouch anastomotic technique, and colonic dysplasia/neoplasia. A sample of the Surgical Clinical Reviewer collected data was validated by a colorectal surgeon at each institution, and kappa's agreement statistics generated. Results Over 1 year, data were collected on a total of 956 cases. Overall, 41.4% of patients had taken a biologic agent in the 60 days before surgery. The 2 most commonly performed procedures were laparoscopic ileocolic resections (159 cases) and subtotal colectomies (151 cases). Overall, 56.8% of cases employed an ileostomy, and 134 ileal pouches were constructed, of which 92.4% used stapled technique. A sample of 214 (22.4%) consecutive cases was validated from 8 institutions. All 5 novel variables were shown to be reliably collected, with excellent agreement for 4 variables (kappa ≥ 0.70) and very good agreement for the presence of colonic dysplasia (kappa = 0.68). Conclusion We report the results of the initial year of implementation of the first disease-specific collaborative within NSQIP. The selected variables were demonstrated to be reliably collected, and this collaborative will facilitate high-quality, large case–volume research specific to the IBD patient population.

Surgical Resection for Crohn’s and Cancer: A Comparison of Disease-Specific Risk Factors and Outcomes

“…ACS-NSQIP does not discriminate between specific settings or case volume of contributing centers and disposes of a limited amount of disease-specific variables. However, the dataset yields a 20% representative sample of the US surgical population [14]. Thus, considering the large scale of this study, a risk-adjusted comparative analysis may help to better understand disease-specific risk factors and outcomes when comparing right-sided colon resections in both conditions.…”

Modified two-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review and meta-analysis of observational research

“…One such collaboration has already begun building an IBD-specific surgical database with promising initial results. [56,57]…”

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

“…This effort is the first to use ACS-NSQIP data to generate a disease-specific surgical outcomes database with statistical validity. 8 In this descriptive report, we further demonstrate the utility of these previously validated data points, which may be used to accurately classify RPC-IPAA staged approaches and provide insight into the current patterns of RPC-IPAA decision making. We then explored potential preoperative predictors of whether patients received immediate or delayed pouch construction operation.…”