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Can we predict anastomotic leak and ileus in patients undergoing colectomy? An updated American College of Surgeons NSQIP analysis of 11,313 patients
Vol. 221, No. 4S2, October 2015
progression was 374.3 (SE) months (range: 8 e 84 months). Inflammatory changes described histologically as Crohn’s disease. RESULTS: Immunohistologic test revealed tuberculosis. All patients were treated with surgical drainage, followed by a 6 to 12 months course of isoniazid. All patients had complete remission of the anorectal symptoms after 12 months, and none of them presented any recurrence after a minimum followup of 10.9 (SE) year (range: 1 to 7 years). CONCLUSIONS: Tuberculosis should be generally be taken into consideration in the differential diagnosis of the ulcerative lesions of the anal and perianal areas despite its rarity. The treatment is usually both surgical and medical so as to get excellent results. Can we predict anastomotic leak and ileus in patients undergoing colectomy? An updated American College of Surgeons NSQIP analysis of 11,313 patients Jennifer W Harris, MD, Daniel L Davenport, PhD, Jitesh A Patel, MD University of Kentucky, Lexington, KY INTRODUCTION: Anastomotic leak (AL) and ileus lead to increased length of stay (LOS), morbidity, and mortality after colectomy in patients without fecal diversion (FD). We hypothesize there are independent perioperative predictors for postoperative AL and ileus. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing colectomy without FD during 2013. Patients without colectomy-specific variables including AL and ileus were excluded. Multivariable modeling determined independent risk factors for AL and ileus as well as the independent contributions to LOS of AL, ileus, organ space surgical site infection (OS SSI) and sepsis. RESULTS: A total of 11,313 patients met criteria: 3.7% had AL; 3.9% OS SSI; 4.3% sepsis; 12.5% ileus and 1.5% mortality at 30days. AL patients had OS SSI 70.2% of the time. Independent predictors of both AL and ileus included male gender, wound class and operative duration > 205 min. Adjusting for significant risk factors, AL increased LOS by 20.2% (95% CI, 13.5-27.3%, p< 0.001), ileus 64.5% (95% CI, 60.3-68.7%, p < 0.001), OS SSI 7.9% (95% CI, 2.1-14.2%, p ¼ 0.008), and sepsis 29.0% (95% CI, 23.0-35.3%, p < 0.001). Thirty-day mortality increased in patients with AL (8.2%, p<0.001) and ileus (5.6%, p<0.001). CONCLUSIONS: Independent predictors for AL and ileus including obstruction, male gender, increased age, smoking status, perioperative transfusion, and open or conversion to open operation identify at-risk patients and may aid optimization of care for those undergoing colectomy without FD.
Scientific Poster Presentations: 2015 Clinical Congress
e57
Colon and rectal surgeons: raising the endoscopy bar Jacquelyn M Charbel Fellow, Amir L Bastawrous, MD, MBA, Daniel Froese, MD, Melinda Hawkins, MD, Rodney Kratz, MD, Raman Menon, MD, Darren R Pollock, MD, Kevin C Long, MD Swedish Medical Center, Seattle, WA INTRODUCTION: To date, there is no published comparison of colorectal surgeons vs gastroenterologists regarding endoscopic quality-metric performance. METHODS: A single-institutional review of the Swedish Colon and Rectal Surgery Department was conducted from July 2013 through June 2014. A total of 1,099 colonoscopic procedures were included in the study. Male patients comprised 54.4% (n ¼ 598) cases. Qualitative metrics investigated include polyp detection rate, adenoma detection rate, and sessile serrated polyp rate. Quantitative metrics include cecal intubation rate and time, and withdrawal time. RESULTS: The findings for this surgical practice reveal an overall polyp detection rate of 52.74%. The overall adenoma detection rate was 38.76%. The adenoma sub-set group of sessile serrated polyps was detected at a rate of 9.00%. Analysis revealed a 99.0% cecal intubation rate with an average cecal intubation time of 8.68 minutes. The average recorded withdrawal time of a colonoscopy without biopsy was 9.16 minutes. The average recorded withdrawal time during which 1 biopsy or more was performed totaled 15.27 minutes. CONCLUSIONS: Based on the aforementioned results, it is evident that fellowship-trained colorectal surgeons are meeting and exceeding the current national guidelines set forth by the ACG. A large multicenter study suggests a withdrawal period of 9 minutes allows for greater detection of polyps (6). The average withdrawal time for a diagnostic colonoscopy was 9.16 minutes, which may play a role in the overall adenoma detection rate of 38.76%. It is possible that a 9 minute withdrawal may increase the efficacy of colonoscopy, leading to higher polyp detection rates. Colorectal cancer in low and middle income countries (LMIC), example of Ukrainian paradox Nelya Melnitchouk, MD, Galyna Shabat, MD, PhD, Maria Traa, MD, Ronald Bleday, MD Brigham and Women’s Hospital, Boston, MA; Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine; Tufts Medical Center, Boston, MA INTRODUCTION: CRC incidence is increasing globally and there is a need for better characterization of CRC in LMIC to develop long lasting strategies to combat CRC. METHODS: This is a population based study of trends in CRC incidence, mortality and management in Ukraine from 1999 to 2012. National Cancer Registry of Ukraine was queried and linear model was used in analysis.
progression was 374.3 (SE) months (range: 8 e 84 months). Inflammatory changes described histologically as Crohn’s disease. RESULTS: Immunohistologic test revealed tuberculosis. All patients were treated with surgical drainage, followed by a 6 to 12 months course of isoniazid. All patients had complete remission of the anorectal symptoms after 12 months, and none of them presented any recurrence after a minimum followup of 10.9 (SE) year (range: 1 to 7 years). CONCLUSIONS: Tuberculosis should be generally be taken into consideration in the differential diagnosis of the ulcerative lesions of the anal and perianal areas despite its rarity. The treatment is usually both surgical and medical so as to get excellent results. Can we predict anastomotic leak and ileus in patients undergoing colectomy? An updated American College of Surgeons NSQIP analysis of 11,313 patients Jennifer W Harris, MD, Daniel L Davenport, PhD, Jitesh A Patel, MD University of Kentucky, Lexington, KY INTRODUCTION: Anastomotic leak (AL) and ileus lead to increased length of stay (LOS), morbidity, and mortality after colectomy in patients without fecal diversion (FD). We hypothesize there are independent perioperative predictors for postoperative AL and ileus. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing colectomy without FD during 2013. Patients without colectomy-specific variables including AL and ileus were excluded. Multivariable modeling determined independent risk factors for AL and ileus as well as the independent contributions to LOS of AL, ileus, organ space surgical site infection (OS SSI) and sepsis. RESULTS: A total of 11,313 patients met criteria: 3.7% had AL; 3.9% OS SSI; 4.3% sepsis; 12.5% ileus and 1.5% mortality at 30days. AL patients had OS SSI 70.2% of the time. Independent predictors of both AL and ileus included male gender, wound class and operative duration > 205 min. Adjusting for significant risk factors, AL increased LOS by 20.2% (95% CI, 13.5-27.3%, p< 0.001), ileus 64.5% (95% CI, 60.3-68.7%, p < 0.001), OS SSI 7.9% (95% CI, 2.1-14.2%, p ¼ 0.008), and sepsis 29.0% (95% CI, 23.0-35.3%, p < 0.001). Thirty-day mortality increased in patients with AL (8.2%, p<0.001) and ileus (5.6%, p<0.001). CONCLUSIONS: Independent predictors for AL and ileus including obstruction, male gender, increased age, smoking status, perioperative transfusion, and open or conversion to open operation identify at-risk patients and may aid optimization of care for those undergoing colectomy without FD.
Scientific Poster Presentations: 2015 Clinical Congress
e57
Colon and rectal surgeons: raising the endoscopy bar Jacquelyn M Charbel Fellow, Amir L Bastawrous, MD, MBA, Daniel Froese, MD, Melinda Hawkins, MD, Rodney Kratz, MD, Raman Menon, MD, Darren R Pollock, MD, Kevin C Long, MD Swedish Medical Center, Seattle, WA INTRODUCTION: To date, there is no published comparison of colorectal surgeons vs gastroenterologists regarding endoscopic quality-metric performance. METHODS: A single-institutional review of the Swedish Colon and Rectal Surgery Department was conducted from July 2013 through June 2014. A total of 1,099 colonoscopic procedures were included in the study. Male patients comprised 54.4% (n ¼ 598) cases. Qualitative metrics investigated include polyp detection rate, adenoma detection rate, and sessile serrated polyp rate. Quantitative metrics include cecal intubation rate and time, and withdrawal time. RESULTS: The findings for this surgical practice reveal an overall polyp detection rate of 52.74%. The overall adenoma detection rate was 38.76%. The adenoma sub-set group of sessile serrated polyps was detected at a rate of 9.00%. Analysis revealed a 99.0% cecal intubation rate with an average cecal intubation time of 8.68 minutes. The average recorded withdrawal time of a colonoscopy without biopsy was 9.16 minutes. The average recorded withdrawal time during which 1 biopsy or more was performed totaled 15.27 minutes. CONCLUSIONS: Based on the aforementioned results, it is evident that fellowship-trained colorectal surgeons are meeting and exceeding the current national guidelines set forth by the ACG. A large multicenter study suggests a withdrawal period of 9 minutes allows for greater detection of polyps (6). The average withdrawal time for a diagnostic colonoscopy was 9.16 minutes, which may play a role in the overall adenoma detection rate of 38.76%. It is possible that a 9 minute withdrawal may increase the efficacy of colonoscopy, leading to higher polyp detection rates. Colorectal cancer in low and middle income countries (LMIC), example of Ukrainian paradox Nelya Melnitchouk, MD, Galyna Shabat, MD, PhD, Maria Traa, MD, Ronald Bleday, MD Brigham and Women’s Hospital, Boston, MA; Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine; Tufts Medical Center, Boston, MA INTRODUCTION: CRC incidence is increasing globally and there is a need for better characterization of CRC in LMIC to develop long lasting strategies to combat CRC. METHODS: This is a population based study of trends in CRC incidence, mortality and management in Ukraine from 1999 to 2012. National Cancer Registry of Ukraine was queried and linear model was used in analysis.