학술논문
Better characterization of operation for ulcerative colitis through the National surgical quality improvement program: A 2-year audit of NSQIP-IBD
Document Type
article
Author
Luo, William Y; Holubar, Stefan D; Bordeianou, Liliana; Cosman, C; Hyke, Roxanne; Lee, Edward C; Messaris, Evangelos; Saraidaridis, Julia; Scow, Jeffrey S; Shaffer, Virginia O; Smith, Radhika; Steinhagen, Randolph M; Vaida, Florin; Eisenstein, Samuel; Institutions and Investigators, Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Collaborating; Ramamoorthy, Sonia; Hilbert, Nicholas; Steinhagen, Randolph; Sylla, Patricia; Divino, Celia; Miller, Reba; Deutsch, Michael; Scow, Jeffery; Huggins, Pamela; Shogan, Benjamin; Hyman, Neil; Prachand, Vivek; Sullivan, Sue; Hull, Tracey; Holubar, Stefan; Jia, Xue; Anzlovar, Nancy; Bohne, Susan; Lee, Edward; Valerian, Brian; Keenan, Megan; Goyette, Andrea; Spain, David; De Leon, Elmer; Lewis, William David; Golden, Terry; Crawford, Lynne; Mutch, Matthew; Hall, Bruce; Hirbe, Mitzi; Batten, Joann; Riccardi, Rocco; Kunitake, Hiroko; Antonelli, Donna; Swierzewski, Kathy; Devaney, Lynn; Whyte, Richard; Ward, Mary; Cotter, Mary Beth; Shaffer, Virginia; Sharma, Joe; Lewis, Judy; Sitafalwalla, Shamsah; Kapadia, Muneera; Kresowik, Timothy; Belding-Schmitt, Mary; Fichera, Alessandro; Aguilar, Debbie; Mueller, Martha
Source
The American Journal of Surgery. 221(1)
Subject
Language
Abstract
IntroductionThere 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.MethodsWe 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.Results430 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.ConclusionsOur 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 summaryWe 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.