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

Autor: Luo WY; University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: wyluo@health.ucsd.edu., Holubar SD; Department of Colon & Rectal Surgery, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH, 44195, USA. Electronic address: holubas@ccf.org., Bordeianou L; Colorectal Surgery Program, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114-3117, USA. Electronic address: lbordeianou@mgh.harvard.edu., Cosman BC; 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., Hyke R; Stanford Health Care, 500 Pasteur Dr, Palo Alto, CA, 94304, USA. Electronic address: RHyke@stanfordhealthcare.org., Lee EC; Division of General Surgery, Albany Medical Center, 50 New Scotland Avenue MC-193, 5th Floor, Albany, NY, 12208, USA. Electronic address: leee@amc.edu., Messaris E; 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., Saraidaridis J; 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., Scow JS; Department of Surgery, Penn State Health, 200 Campus Dr, Suite 3100 | Entrance 4, Hershey, PA, 17033, USA. Electronic address: jscow@pennstatehealth.psu.edu., Shaffer VO; 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., Smith R; Department of Surgery, Washington University School of Medicine in St. Louis, 5201 Midamerica Plaza, St. Louis, MO, 63141, USA. Electronic address: radhikasmith@wustl.edu., Steinhagen RM; 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., Vaida F; University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: fvaida@health.ucsd.edu., Eisenstein S; University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: seisenstein@health.ucsd.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2021 Jan; Vol. 221 (1), pp. 174-182. Date of Electronic Publication: 2020 Jun 12.
DOI: 10.1016/j.amjsurg.2020.05.035
Abstrakt: 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.
Competing Interests: Declaration of competing interest 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.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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