Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.
Abstract
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.
Type
Journal articleSubject
AdultAged
Cohort Studies
Colorectal Surgery
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Perioperative Care
Quality Improvement
Retrospective Studies
Surgical Wound Infection
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https://hdl.handle.net/10161/13949Published Version (Please cite this version)
10.1016/j.jamcollsurg.2015.04.008Publication Info
Keenan, 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
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
Paul Speicher
House Staff
Julie K. Marosky Thacker
Associate Professor of Surgery
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