313 BIOLOGICS BEFORE SURGERY FOR IBD - ARE THEY ASSOCIATED WITH POST-OPERATIVE INFECTIOUS OUTCOMES RESULTS FROM THE A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM INFLAMMATORY BOWEL DISEASE COLLABORATIVE IN >1500 PATIENTS

2020 ◽  
Vol 158 (6) ◽  
pp. S-1510 ◽  
Author(s):  
Stefan D. Holubar ◽  
Xue Jai ◽  
Tracy L. Hull ◽  
Neil Hyman ◽  
Randolph Steinhagen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
Inflammatory Bowel

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

2019 ◽  
Vol 25 (11) ◽  
pp. 1731-1739 ◽  
Author(s):  
Samuel Eisenstein ◽  
Stefan D Holubar ◽  
Nicholas Hilbert ◽  
Liliana Bordeianou ◽  
Lynne A Crawford ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Surgical Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Improvement Project ◽  
Acs Nsqip ◽  
Inflammatory Bowel ◽  
Disease Specific

Abstract Background 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.

Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

2020 ◽  
Author(s):  
George A. Beyer ◽  
Karan Dua ◽  
Neil V. Shah ◽  
Joseph P. Scollan ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Extremity ◽  
Free Flap ◽  
Quality Improvement Program ◽  
Readmission Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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