TY - JOUR
T1 - Effect of diagnosis on outcomes in the setting of enhanced recovery protocols
AU - Ban, Kristen A.
AU - Berian, Julia R.
AU - Liu, Jason B.
AU - Ko, Clifford Y.
AU - Feldman, Liane S.
AU - Thacker, Julie K.M.
N1 - Publisher Copyright:
© 2018 The ASCRS.
PY - 2018
Y1 - 2018
N2 - Background: Implementation of enhanced recovery protocols in colectomy reduces length of stay and morbidity, but it remains unknown whether benefits vary by clinical diagnosis. Objective: Outcomes after colectomy in the setting of enhanced recovery protocols were compared for 3 diagnoses: 1) neoplasm, 2) diverticulitis, and 3) IBD. Design: This was a retrospective registry-based cohort study. Settings: Novel enhanced recovery variables were released in the American College of Surgeons National Surgical Quality Improvement Program in 2014. Patients: Patients with enhanced recovery variable data undergoing elective colectomy (July 2014 to December 2015) for neoplasm, diverticulitis, or IBD were included. Main Outcome Measures: The primary outcome of interest was prolonged length of stay. Additional outcomes included surgical site infection, death/serious morbidity, reoperation, readmission, and days to achieve per os pain control, tolerance of a diet, and return of bowel function. Results: We identified 4620 patients with neoplasm, 1730 patients with diverticulitis, and 593 patients with IBD. Patients undergoing colectomy for IBD were more likely to have prolonged length of stay (OR, 1.98; 95% CI, 1.46-2.69), death/serious morbidity (OR, 1.62; 95% CI, 1.13-2.32), and readmission (OR, 1.54; 95% CI, 1.15-2.08) compared with patients with neoplasm. Patients with IBD took longer than patients with neoplasm or diverticulitis to achieve per os pain control (mean, 4.2 days vs 3.4 and 3.5 days, p < 0.001) and tolerate a diet (mean, 4.1 days vs 3.7 and 3.5 days, p < 0.001). No statistically significant differences in outcomes between patients with neoplasm and diverticulitis were seen. Limitations: There may be heterogeneity among implemented enhanced recovery protocols. Conclusions: Patients undergoing colectomy for neoplasm and diverticulitis have improved outcomes in comparison with patients undergoing colectomy for IBD. Knowledge of expected outcomes for patients with different diagnoses may inform clinician and patient expectations.
AB - Background: Implementation of enhanced recovery protocols in colectomy reduces length of stay and morbidity, but it remains unknown whether benefits vary by clinical diagnosis. Objective: Outcomes after colectomy in the setting of enhanced recovery protocols were compared for 3 diagnoses: 1) neoplasm, 2) diverticulitis, and 3) IBD. Design: This was a retrospective registry-based cohort study. Settings: Novel enhanced recovery variables were released in the American College of Surgeons National Surgical Quality Improvement Program in 2014. Patients: Patients with enhanced recovery variable data undergoing elective colectomy (July 2014 to December 2015) for neoplasm, diverticulitis, or IBD were included. Main Outcome Measures: The primary outcome of interest was prolonged length of stay. Additional outcomes included surgical site infection, death/serious morbidity, reoperation, readmission, and days to achieve per os pain control, tolerance of a diet, and return of bowel function. Results: We identified 4620 patients with neoplasm, 1730 patients with diverticulitis, and 593 patients with IBD. Patients undergoing colectomy for IBD were more likely to have prolonged length of stay (OR, 1.98; 95% CI, 1.46-2.69), death/serious morbidity (OR, 1.62; 95% CI, 1.13-2.32), and readmission (OR, 1.54; 95% CI, 1.15-2.08) compared with patients with neoplasm. Patients with IBD took longer than patients with neoplasm or diverticulitis to achieve per os pain control (mean, 4.2 days vs 3.4 and 3.5 days, p < 0.001) and tolerate a diet (mean, 4.1 days vs 3.7 and 3.5 days, p < 0.001). No statistically significant differences in outcomes between patients with neoplasm and diverticulitis were seen. Limitations: There may be heterogeneity among implemented enhanced recovery protocols. Conclusions: Patients undergoing colectomy for neoplasm and diverticulitis have improved outcomes in comparison with patients undergoing colectomy for IBD. Knowledge of expected outcomes for patients with different diagnoses may inform clinician and patient expectations.
KW - Colorectal surgery
KW - Enhanced recovery
KW - Enhanced recovery after surgery
KW - Inflammatory bowel disease
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U2 - 10.1097/DCR.0000000000001102
DO - 10.1097/DCR.0000000000001102
M3 - Article
C2 - 29878952
AN - SCOPUS:85049240208
SN - 0012-3706
VL - 61
SP - 847
EP - 853
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 7
ER -