Colectomy Performance Improvement within NSQIP 2005-2008

Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Journal of Surgical Research (Impact Factor: 1.94). 07/2011; 171(1):e9-13. DOI: 10.1016/j.jss.2011.06.052
Source: PubMed


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.
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.
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).
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.

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    • "A National Surgical Quality Improvement Program analysis of colon resection trends in the United States involving 48,247 patients between 2005 and 2008 revealed no significant yearly differences in reoperations (7.4%e8.1%) [21]. Reports based on administrative databases also have limitations because most have not foreseen unplanned reoperations and have limitations regarding numerator and denominator construction [22] "

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    • "One example of this relates to colectomies performed in ACS-NSQIP enrolled hospitals. These operations have been shown to increasingly be performed laparoscopically in these hospitals, with significant reductions in most major complications (including surgical-site infections, pneumonia and sepsis) [51]. One should remember despite the potential benefits of the ACS-NSQIP programme that there are limits to its usefulness. "
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