Details

Autor(en) / Beteiligte

• Ozhathil, Deepak K., B.S
• Li, YouFu, M.D., M.P.H
• Smith, Jillian K., M.D., M.P.H
• Witkowski, Elan, M.D
• Coyne, Elizaveta Ragulin, M.D
• Alavi, Karim, M.D., M.P.H
• Tseng, Jennifer F., M.D., M.P.H
• Shah, Shimul A., M.D

Titel

Colectomy Performance Improvement within NSQIP 2005–2008

Ist Teil von

• The Journal of surgical research, 2011-11, Vol.171 (1), p.e9-e13

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2011

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.