Multicenter Study

. 2021 Jan;221(1):174-182.

doi: 10.1016/j.amjsurg.2020.05.035. Epub 2020 Jun 12.

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

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, Affiliations

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.

PMID: 32928540
PMCID: PMC7736277
DOI: 10.1016/j.amjsurg.2020.05.035

Multicenter Study

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

William Y Luo et al. Am J Surg. 2021 Jan.

. 2021 Jan;221(1):174-182.

doi: 10.1016/j.amjsurg.2020.05.035. Epub 2020 Jun 12.

Authors

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.

PMID: 32928540
PMCID: PMC7736277
DOI: 10.1016/j.amjsurg.2020.05.035

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.

PubMed Disclaimer

Conflict of interest statement

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.

Figures

**Figure 1:**
Classification schema for RPC-IPAA staged approaches based on ICD coding, CPT coding, and ileostomy status.

See this image and copyright information in PMC

References

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1. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54 e42; quiz e30. - PubMed
1. Loftus CG, Loftus EV Jr., Harmsen WS, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, 1940–2000. Inflamm Bowel Dis. 2007;13(3):254–261. - PubMed
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Better characterization of operation for ulcerative colitis through the National surgical quality improvement program: A 2-year audit of NSQIP-IBD

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical