A. A. Gullick1,2, L. E. Goss1,2, D. I. Chu1,2, C. Balentine1,2, M. S. Morris1,2 1University Of Alabama at Birmingham,Gastrointestinal Surgery,Birmingham, Alabama, USA 2VA AL Healthcare System,Surgery,Birmingham, AL, USA
Introduction: Patients have high complication rates following Colorectal surgery and some of these outcomes are publically reported. Outcomes following colectomy are extensively reported but most studies fail to consider surgical indication or are performed on a cohort with a single indication such as colorectal cancer. We aim to examine our hypothesis that postoperative outcomes vary based on surgical indication in non-emergent colorectal procedures.
Methods: We queried the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) colectomy procedure targeted database for non-emergency cases and stratified patients by primary indication for surgery. Patient and operative characteristics were compared. Primary outcomes are30 day all-cause readmission rates and post-surgical length of stay (poLOS). Secondary outcomes included post-operative complications. Chi-square and Wilcoxon Rank Sums tests were used to determine differences among categorical and continuous variables, respectively. Backwards linear regression was performed to identify risk factors for poLOS and backwards logistic regression was used to identify 30 day readmission risk factors.
Results: Of 52,617 patients who underwent elective colectomies, the indications included colorectal cancer (CRC) (46.97%),diverticular disease (DV) (23.05%), other benign disease (OBD) (21.10%) and inflammatory bowel disease (IBD) (8.88%). Overall, 52.2% were female, the majority white (78.9%) and had a median age of 62.0 (52-72.0). IBD patients were more likely to be underweight, and most were on steroid medications, while those with diverticular disease were more likely to have diabetes, smoke and have hypertension When examining post-operative complications, IBD patients experienced the greatest proportion of organ space infections (6.65%), while those with colorectal cancer experienced the greatest proportion of post-operative bleeding (11.37%). 30 day mortality was highest in those presenting with other benign disease (1.77%) and lowest in IBD patients (.30%). Readmission rates were significantly higher in those with IBD (13.97% vs 10.14%, 8.56% and 10.1% , p<0.001). On adjusted comparisons, IBD patients had longer poLOS compared to other benign disease, diverticular disease and colorectal cancer (6.91 vs 6.86, 5.74 and 6.68, p<0.001) and was a significant predictor of readmission (OR: 1.18(1.03-1.36)).
Conclusion: For patients undergoing colorectal surgery, the indication for surgery needs to be considered when reporting rates of readmission, surgical site infections and length of stay. Patients with IBD are at particular high-risk for post-operative complications including 30-day readmission and total number of complications. As financial penalties are tied to these outcomes, hospitals who serve higher proportions of IBD patients will be disproportionally affected.