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

2021 ◽  
Vol 160 (3) ◽  
pp. S78-S79
Author(s):  
Stefan Holubar ◽  
Samuel Eisenstein ◽  
Liliana Bordeianou ◽  
Xue Jia ◽  
Tracy Hull ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Infectious Complications ◽  
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.

scholarly journals OP25 Biologics before surgery for IBD: Are they associated with post-operative infectious outcomes? Results from the national surgical quality improvement programme inflammatory bowel disease collaborative

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S022-S023
Author(s):  
S Holubar ◽  
X Jai ◽  
T Hull ◽  
N Hyman ◽  
S Ramamoorthy ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Infectious Complication ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Infectious Complications ◽  
Site Infection ◽  
Steroid Use ◽  
Surgical Quality ◽  
Inflammatory Bowel

Abstract Background We aimed to utilise the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Inflammatory Bowel Disease (IBD) Collaborative, which includes disease-specific variables, to assess the association between preoperative biologic exposure and post-operative infectious complications in the largest cohort reported to date. Methods Were obtained from ten IBD centres from 2017 - 2018. Univariate and multivariate analyses were performed, with any biologic use within 60-days of surgery as the primary predictor, adjusting for diagnosis, chronic steroid use, immunomodulator (IMM) use, ostomy construction, anaemia, malnutrition, operative length, emergency surgery, and other variables with p < 0.05 from the univariate analysis. The primary endpoint was any (composite) infectious complication, and the secondary endpoint was any (composite) surgical site infection. Results A total of 1,562 patients were included, of which 832 (53%) were not exposed to biologics, and 730 (47%) were exposed to biologics before surgery. The biologics group had more preoperative weight loss, lower albumin, more systemic sepsis, more IMM and steroid use, and more had Crohn’s disease (all p < 0.001). The biologics group were also more likely to receive a new ostomy and to have a colectomy (vs. proctectomy or small bowel procedure), and fewer had elective surgery (all p < 0.001). On univariate analysis (Table 1), compared with no biologic exposure, biologic exposure was not associated with any infectious complications, any surgical site infections, anastomotic leak after colectomy, or other post-operative outcomes, but was associated with increased rate of anastomotic leak after proctectomy (n = 423), 6.7% vs. 1.9%, p = 0.02. With respect to the primary and secondary outcomes, the results of the multivariate analyses are shown in Table 2. Biologics were shown not to be associated with any infectious complication (OR 0.88, 95% CI 0.54 – 1.42) or any surgical site infection (OR 0.77, 95% CI 0.46 – 1.28), while Crohn’s disease was associated with any infectious complications (OR 2.11 95% CI 1.12 – 4, p = 0.02). Conclusion In the largest retrospective cohort to date, we found that biologics exposure within 60 days of surgery for IBD, using a well-validated methodology and after vigorous adjustment for disease- and surgery-specific covariates, was not associated with post-operative infectious or surgical site infectious complications.

scholarly journals BIOLOGICS BEFORE SURGERY FOR IBD: ARE THEY ASSOCIATED WITH POST-OPERATIVE INFECTIOUS COMPLICATIONS? RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM INFLAMMATORY BOWEL DISEASE COLLABORATIVE IN >1500 PATIENTS

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Stefan Holubar ◽  
Samuel Eisenstein ◽  
Liliana Bordeianou ◽  
Xue Jia ◽  
Tracy Hull ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Infectious Complication ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Infectious Complications ◽  
Site Infection ◽  
Improvement Program ◽  
Steroid Use ◽  
Surgical Quality ◽  
Inflammatory Bowel

Abstract Background We aimed to utilize the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Inflammatory Bowel Disease (IBD) Collaborative, which includes disease-specific variables, to assess the association between preoperative biologic exposure and post-operative infectious complications in the largest cohort reported to date. Methods Data was obtained from ten IBD centers from 2017 - 2018. Univariate and multivariate analyses were performed, with any biologic use within 60-days of surgery as the primary predictor, adjusting for diagnosis, chronic steroid use, immunomodulator (IMM) use, ostomy construction, anemia, malnutrition, operative length, emergency surgery, and other variables with p<0.05 from the univariate analysis. The primary endpoint was any (composite) infectious complication, and the secondary endpoint was any (composite) surgical site infection. Results A total of 1,562 patients were included, of which 832 (53%) were not exposed to biologics, and 730 (47%) were exposed to biologics before surgery. The biologics group had more preoperative weight loss, lower albumin, more systemic sepsis, more IMM and steroid use, and more had Crohn’s disease (all p<0.001). The biologics group were also more likely to receive a new ostomy and to have a colectomy (vs. proctectomy or small bowel procedure), and fewer had elective surgery (all p<0.001). On univariate analysis (Table 1), compared with no biologic exposure, biologic exposure was not associated with any infectious complications, any surgical site infections, anastomotic leak after colectomy, or other post-operative outcomes, but was associated with increased rate of anastomotic leak after proctectomy (n=423), 6.7% vs. 1.9%, p=0.02. With respect to the primary and secondary outcomes, the results of the multivariate analyses are shown in Table 2. Biologics were shown not to be associated with any infectious complication (OR 0.88, 95%CI 0.54 – 1.42) or any surgical site infection (OR 0.77, 95% CI 0.46 – 1.28), while Crohn’s disease was associated with any infectious complications (OR 2.11 95% CI 1.12 – 4, p=0.02). Conclusions In the largest nationally representative retrospective cohort to date, we found that biologics exposure within 60-days of surgery for IBD, using well-validated methodology and after vigorous adjustment for disease- and surgery-specific covariates, was not associated with post-operative infectious or surgical site infectious complications.

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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