Title

Colectomy performance improvement within NSQIP 2005-2008

UMMS Affiliation

Department of Surgery, Surgical Outcomes Analysis and Research

Date

11-2011

Document Type

Article

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Colectomy; Databases, Factual; Emergency Treatment; Female; Humans; Laparoscopy; Male; Middle Aged; Morbidity; Outcome and Process Assessment (Health Care); Postoperative Complications; *Quality Assurance, Health Care; Retrospective Studies; Risk Factors; Surgical Procedures, Elective; Young Adult

Disciplines

Surgery

Abstract

BACKGROUND: All open and laparoscopic colectomies submitted to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were evaluated for trends and improvements in operative outcomes.

METHODS: 48,247 adults (>/=18 y old) underwent colectomy in ACS NSQIP, as grouped by surgical approach (laparoscopic versus open), urgency (emergent versus elective), and operative year (2005 to 2008). Primary outcomes measured morbidity, mortality, perioperative, and postoperative complications.

RESULTS: The proportion of laparoscopic colectomies performed increased annually (26.3% to 34.0%), while open colectomies decreased (73.7% to 66.0%; P < 0.0001). Most emergent colectomies were open procedures (93.5%) representing 24.3% of all open cases. The overall risk-adjusted morbidity and mortality for all colectomy procedures did not show a statistically significant change over time, however, morbidity and mortality increased among open colectomies (r = 0.03) and decreased among laparoscopic colectomies (r = -0.04; P < 0.0001). Postoperative complications reduced significantly including superficial surgical site infections (9.17% to 8.20%, P < 0.004), pneumonia (4.60% to 3.97%, P < 0.0001), and sepsis (4.72%, 2005; 6.81%, 2006; 5.62%, 2007; 5.09%, 2008; P < 0.0002). Perioperative improvements included operative time (169.2 to 160.0 min), PRBC transfusions (0.27 to 0.25 units) and length of stay (10.5 to 6.61 d; P < 0.0001).

CONCLUSION: It appears that laparoscopic colectomies are growing in popularity over open colectomies, but the need for emergent open procedures remains unchanged. Across all colectomies, however, key postoperative and perioperative complications have improved over time. Participation in ACS NSQIP demonstrates quality improvement and may encourage greater enrollment.

Comments

Citation: J Surg Res. 2011 Nov;171(1):e9-13. Epub 2011 Jul 23. Link to article on publisher's site

Medical student Deepak Ozhathill participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed