Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.
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BACKGROUND: The purpose of this study was to examine the impact of the sequential implementation of the enhanced recovery program (ERP) and surgical site infection bundle (SSIB) on short-term outcomes in colorectal surgery (CRS) to determine if the presence of multiple standardized care programs provides additive benefit. STUDY DESIGN: Institutional ACS-NSQIP data were used to identify patients who underwent elective CRS from September 2006 to March 2013. The cohort was stratified into 3 groups relative to implementation of the ERP (February 1, 2010) and SSIB (July 1, 2011). Unadjusted characteristics and 30-day outcomes were assessed, and inverse proportional weighting was then used to determine the adjusted effect of these programs. RESULTS: There were 787 patients included: 337, 165, and 285 in the pre-ERP/SSIB, post-ERP/pre-SSIB, and post-ERP/SSIB periods, respectively. After inverse probability weighting (IPW) adjustment, groups were balanced with respect to patient and procedural characteristics considered. Compared with the pre-ERP/SSIB group, the post-ERP/pre-SSIB group had significantly reduced length of hospitalization (8.3 vs 6.6 days, p = 0.01) but did not differ with respect to postoperative wound complications and sepsis. Subsequent introduction of the SSIB then resulted in a significant decrease in superficial SSI (16.1% vs 6.3%, p < 0.01) and postoperative sepsis (11.2% vs 1.8%, p < 0.01). Finally, inflation-adjusted mean hospital cost for a CRS admission fell from $31,926 in 2008 to $22,044 in 2013 (p < 0.01). CONCLUSIONS: Sequential implementation of the ERP and SSIB provided incremental improvements in CRS outcomes while controlling hospital costs, supporting their combined use as an effective strategy toward improving the quality of patient care.
Elective Surgical Procedures
Outcome and Process Assessment (Health Care)
Surgical Wound Infection
Published Version (Please cite this version)10.1016/j.jamcollsurg.2015.04.008
Publication InfoKeenan, Jeffrey E; Speicher, Paul J; Nussbaum, Daniel P; Adam, Mohamed Abdelgadir; Miller, Timothy E; Mantyh, Christopher R; & Thacker, Julie KM (2015). Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs. J Am Coll Surg, 221(2). pp. 404-414.e1. 10.1016/j.jamcollsurg.2015.04.008. Retrieved from https://hdl.handle.net/10161/13949.
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Christopher Ritchie Mantyh
Professor of Surgery
Neurogenic inflammation Ulcerative colitis Crohn's disease Neuropeptides Receptors Vanilloid receptor Substance P Intestinal motility Colorectal cancer outcomes Colon cancer Rectal cancer
Timothy Ellis Miller
Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.
Daniel Philip Nussbaum
Assistant Professor of Surgery
Julie K. Marosky Thacker
Associate Professor of Surgery
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