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

Samuel Eisenstein, Stefan D. Holubar, Nicholas Hilbert, Liliana Bordeianou, Lynne A. Crawford, Bruce Hall, Tracy Hull, Neil Hyman, Megan Keenan, Hiroko Kunitake, Edward C. Lee, William D. Lewis, David Maron, Evangelos Messaris, Reba Miller, Matthew Mutch, Gail Ortenzi, Sonia Ramamoorthy, Radhika Smith, Randolph M. SteinhagenSteven D. Wexner

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1731-1739
Number of pages9
JournalInflammatory bowel diseases
Volume25
Issue number11
DOIs
StatePublished - Oct 18 2019

Keywords

  • ACS-NSQIP
  • Crohn's disease
  • biologic
  • colectomy
  • colorectal cancer
  • dysplasia
  • ileal pouch anal anastomosis
  • immunomodulator
  • inflammatory bowel disease
  • laparoscopy
  • ulcerative colitis

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