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Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.

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Date
2015-08
Authors
Keenan, Jeffrey E
Speicher, Paul J
Nussbaum, Daniel P
Adam, Mohamed Abdelgadir
Miller, Timothy E
Mantyh, Christopher R
Thacker, Julie KM
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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 article
Subject
Adult
Aged
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
Permalink
https://hdl.handle.net/10161/13949
Published Version (Please cite this version)
10.1016/j.jamcollsurg.2015.04.008
Publication 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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Scholars@Duke

Mantyh

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
Miller

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.
Nussbaum

Daniel Philip Nussbaum

Assistant Professor of Surgery
Speicher

Paul Speicher

House Staff
Thacker

Julie K. Marosky Thacker

Associate Professor of Surgery
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Alphabetical list of authors with Scholars@Duke profiles.
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