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

Keenan, Jeffrey E

Speicher, Paul J

Nussbaum, Daniel P

Adam, Mohamed Abdelgadir

Miller, Timothy E

Mantyh, Christopher R

Thacker, Julie KM

United States

2017-04-06T15:57:05Z

2017-04-06T15:57:05Z

2015-08

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.

https://www.ncbi.nlm.nih.gov/pubmed/26206639

S1072-7515(15)00310-5

1879-1190

https://hdl.handle.net/10161/13949

eng

Ovid Technologies (Wolters Kluwer Health)

J Am Coll Surg

10.1016/j.jamcollsurg.2015.04.008

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

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

Journal article

Speicher, Paul J|0000-0002-2209-9465

Nussbaum, Daniel P|0000-0003-3070-6605

Miller, Timothy E|0000-0001-8567-6680

Mantyh, Christopher R|0000-0003-0361-7252

https://www.ncbi.nlm.nih.gov/pubmed/26206639

404

414.e1

2

Anesthesiology

Anesthesiology, General, Vascular, High Risk Transplant & Critical Care

Clinical Science Departments

Duke

Duke Cancer Institute

Institutes and Centers

School of Medicine

Staff

Published

221