Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

Susanna S. Hill; Kathryn E. Ottaviano; David C. Palange; A. David Chismark; Brian T. Valerian; Jonathan J. Canete; Edward C. Lee; Samuel Eisenstein; Sonia Ramamoorthy; Nicholas Hilbert; Austin Du; Tracey Hull; Stefan Holubar; Xue Jia; Nancy Anzlovar; Sue Bohne; Alessandro Fichera; Debbie Aguilar; Martha Mueller; Rocco Riccardi; Liliana Bordeianou; Hiroko Kunitake; Donna Antonelli; Kathy Swierzewski; Lynn Devaney; Cindy Kin; David Spain; Roxanne Hyke; Elmer De Leon; Aimee Torbela; Megan Keenan; Andrea Goyette; Evangelos Messaris; Richard Whyte; Mary Ward; Mary Beth Cotter; Julia Saraidaridis; W. David Lewis; Mary Sansone; Lynne Crawford; Michael Deutsch; Jeffrey Scow; Pam Huggins; Virginia Shaffer; Joe Sharma; Shamsah Sitafalwalla; Radhika Smith; Matthew Mutch; Bruce Hall; Mitzi Hirbe; Joann Batten; Randolph Steinhagen; Sergey Khaitov; Patricia Sylla; Celia Divino; Reba Miller; Kinga Skowron Olortegui; Neil Hyman; Vivek Prachand; Sue Sullivan; Lorice Pullins; Carmen Barc; Jennifer Hrabe; Muneera Kapadia; Mary Belding-Schmitt; James Yoo; Joel Goldberg; Felix Akinbami; Jill Steinberg

doi:10.1097/DCR.0000000000002831

Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

Susanna S. Hill, Kathryn E. Ottaviano, David C. Palange, A. David Chismark, Brian T. Valerian, Jonathan J. Canete, Edward C. Lee, Samuel Eisenstein, Sonia Ramamoorthy, Nicholas Hilbert, Austin Du, Tracey Hull, Stefan Holubar, Xue Jia, Nancy Anzlovar, Sue Bohne, Alessandro Fichera, Debbie Aguilar, Martha Mueller, Rocco RiccardiLiliana Bordeianou, Hiroko Kunitake, Donna Antonelli, Kathy Swierzewski, Lynn Devaney, Cindy Kin, David Spain, Roxanne Hyke, Elmer De Leon, Aimee Torbela, Megan Keenan, Andrea Goyette, Evangelos Messaris, Richard Whyte, Mary Ward, Mary Beth Cotter, Julia Saraidaridis, W. David Lewis, Mary Sansone, Lynne Crawford, Michael Deutsch, Jeffrey Scow, Pam Huggins, Virginia Shaffer, Joe Sharma, Shamsah Sitafalwalla, Radhika Smith, Matthew Mutch, Bruce Hall, Mitzi Hirbe, Joann Batten, Randolph Steinhagen, Sergey Khaitov, Patricia Sylla, Celia Divino, Reba Miller, Kinga Skowron Olortegui, Neil Hyman, Vivek Prachand, Sue Sullivan, Lorice Pullins, Carmen Barc, Jennifer Hrabe, Muneera Kapadia, Mary Belding-Schmitt, James Yoo, Joel Goldberg, Felix Akinbami, Jill Steinberg

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BACKGROUND: Patients with IBD are challenging to manage perioperatively because of disease complexity and multiple comorbidities. OBJECTIVE: To identify whether preoperative factors and operation type were associated with extended postoperative length of stay after IBD-related surgery, defined by 75th percentile or greater (n = 926; 30.8%). DESIGN: This was a cross-sectional study based on a retrospective multicenter database. SETTING: The National Surgery Quality Improvement Program-Inflammatory Bowel Disease Collaborative captured data from 15 high-volume sites. PATIENTS: A total of 3008 patients with IBD (1710 with Crohn's disease and 1291 with ulcerative colitis) with a median postoperative length of stay of 4 days (interquartile range, 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES: The primary outcome was extended postoperative length of stay. RESULTS: On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under receiver operating characteristic curve = 0.85). Clinically significant contributors that increased postoperative length of stay were rectal surgery (vs colon; OR, 2.13; 95% CI, 1.52-2.98), new ileostomy (vs no ileostomy; OR, 1.50; 95% CI, 1.15-1.97), preoperative hospitalization (OR, 13.45; 95% CI, 10.15-17.84), non-home discharge (OR, 4.78; 95% CI, 2.27-10.08), hypoalbuminemia (OR, 1.66; 95% CI, 1.27-2.18), and bleeding disorder (OR, 2.42; 95% CI, 1.22-4.82). LIMITATIONS: Retrospective review of only high-volume centers. CONCLUSIONS: Patients with IBD who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia, and ASA classes 3 to 5. Chronic corticosteroid, immunologic, small molecule, and biologic agent use were insignificant on multivariable analysis. See Video Abstract.

Original language	English
Pages (from-to)	97-106
Number of pages	10
Journal	Diseases of the Colon and Rectum
Volume	67
Issue number	1
DOIs	https://doi.org/10.1097/DCR.0000000000002831
State	Published - 1 Jan 2024

Keywords

Crohn's disease
Length of stay
Perioperative course
Postoperative complications
Ulcerative colitis

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10.1097/DCR.0000000000002831

Cite this

Hill, S. S., Ottaviano, K. E., Palange, D. C., Chismark, A. D., Valerian, B. T., Canete, J. J., Lee, E. C., Eisenstein, S., Ramamoorthy, S., Hilbert, N., Du, A., Hull, T., Holubar, S., Jia, X., Anzlovar, N., Bohne, S., Fichera, A., Aguilar, D., Mueller, M., ... Steinberg, J. (2024). Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis. Diseases of the Colon and Rectum, 67(1), 97-106. https://doi.org/10.1097/DCR.0000000000002831

@article{4cd7866bb3e347a5b13992db0cd4eebc,

title = "Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis",

abstract = "BACKGROUND: Patients with IBD are challenging to manage perioperatively because of disease complexity and multiple comorbidities. OBJECTIVE: To identify whether preoperative factors and operation type were associated with extended postoperative length of stay after IBD-related surgery, defined by 75th percentile or greater (n = 926; 30.8%). DESIGN: This was a cross-sectional study based on a retrospective multicenter database. SETTING: The National Surgery Quality Improvement Program-Inflammatory Bowel Disease Collaborative captured data from 15 high-volume sites. PATIENTS: A total of 3008 patients with IBD (1710 with Crohn's disease and 1291 with ulcerative colitis) with a median postoperative length of stay of 4 days (interquartile range, 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES: The primary outcome was extended postoperative length of stay. RESULTS: On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under receiver operating characteristic curve = 0.85). Clinically significant contributors that increased postoperative length of stay were rectal surgery (vs colon; OR, 2.13; 95% CI, 1.52-2.98), new ileostomy (vs no ileostomy; OR, 1.50; 95% CI, 1.15-1.97), preoperative hospitalization (OR, 13.45; 95% CI, 10.15-17.84), non-home discharge (OR, 4.78; 95% CI, 2.27-10.08), hypoalbuminemia (OR, 1.66; 95% CI, 1.27-2.18), and bleeding disorder (OR, 2.42; 95% CI, 1.22-4.82). LIMITATIONS: Retrospective review of only high-volume centers. CONCLUSIONS: Patients with IBD who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia, and ASA classes 3 to 5. Chronic corticosteroid, immunologic, small molecule, and biologic agent use were insignificant on multivariable analysis. See Video Abstract.",

keywords = "Crohn's disease, Length of stay, Perioperative course, Postoperative complications, Ulcerative colitis",

author = "Hill, {Susanna S.} and Ottaviano, {Kathryn E.} and Palange, {David C.} and Chismark, {A. David} and Valerian, {Brian T.} and Canete, {Jonathan J.} and Lee, {Edward C.} and Samuel Eisenstein and Sonia Ramamoorthy and Nicholas Hilbert and Austin Du and Tracey Hull and Stefan Holubar and Xue Jia and Nancy Anzlovar and Sue Bohne and Alessandro Fichera and Debbie Aguilar and Martha Mueller and Rocco Riccardi and Liliana Bordeianou and Hiroko Kunitake and Donna Antonelli and Kathy Swierzewski and Lynn Devaney and Cindy Kin and David Spain and Roxanne Hyke and {De Leon}, Elmer and Aimee Torbela and Megan Keenan and Andrea Goyette and Evangelos Messaris and Richard Whyte and Mary Ward and {Beth Cotter}, Mary and Julia Saraidaridis and Lewis, {W. David} and Mary Sansone and Lynne Crawford and Michael Deutsch and Jeffrey Scow and Pam Huggins and Virginia Shaffer and Joe Sharma and Shamsah Sitafalwalla and Radhika Smith and Matthew Mutch and Bruce Hall and Mitzi Hirbe and Joann Batten and Randolph Steinhagen and Sergey Khaitov and Patricia Sylla and Celia Divino and Reba Miller and {Skowron Olortegui}, Kinga and Neil Hyman and Vivek Prachand and Sue Sullivan and Lorice Pullins and Carmen Barc and Jennifer Hrabe and Muneera Kapadia and Mary Belding-Schmitt and James Yoo and Joel Goldberg and Felix Akinbami and Jill Steinberg",

year = "2024",

month = jan,

day = "1",

doi = "10.1097/DCR.0000000000002831",

language = "English",

volume = "67",

pages = "97--106",

journal = "Diseases of the Colon and Rectum",

issn = "0012-3706",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Hill, SS, Ottaviano, KE, Palange, DC, Chismark, AD, Valerian, BT, Canete, JJ, Lee, EC, Eisenstein, S, Ramamoorthy, S, Hilbert, N, Du, A, Hull, T, Holubar, S, Jia, X, Anzlovar, N, Bohne, S, Fichera, A, Aguilar, D, Mueller, M, Riccardi, R, Bordeianou, L, Kunitake, H, Antonelli, D, Swierzewski, K, Devaney, L, Kin, C, Spain, D, Hyke, R, De Leon, E, Torbela, A, Keenan, M, Goyette, A, Messaris, E, Whyte, R, Ward, M, Beth Cotter, M, Saraidaridis, J, Lewis, WD, Sansone, M, Crawford, L, Deutsch, M, Scow, J, Huggins, P, Shaffer, V, Sharma, J, Sitafalwalla, S, Smith, R, Mutch, M, Hall, B, Hirbe, M, Batten, J, Steinhagen, R , Khaitov, S, Sylla, P, Divino, C, Miller, R, Skowron Olortegui, K, Hyman, N, Prachand, V, Sullivan, S, Pullins, L, Barc, C, Hrabe, J, Kapadia, M, Belding-Schmitt, M, Yoo, J, Goldberg, J, Akinbami, F & Steinberg, J 2024, 'Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis', Diseases of the Colon and Rectum, vol. 67, no. 1, pp. 97-106. https://doi.org/10.1097/DCR.0000000000002831

Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis. / Hill, Susanna S.; Ottaviano, Kathryn E.; Palange, David C. et al.
In: Diseases of the Colon and Rectum, Vol. 67, No. 1, 01.01.2024, p. 97-106.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay

T2 - A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

AU - Hill, Susanna S.

AU - Ottaviano, Kathryn E.

AU - Palange, David C.

AU - Chismark, A. David

AU - Valerian, Brian T.

AU - Canete, Jonathan J.

AU - Lee, Edward C.

AU - Eisenstein, Samuel

AU - Ramamoorthy, Sonia

AU - Hilbert, Nicholas

AU - Du, Austin

AU - Hull, Tracey

AU - Holubar, Stefan

AU - Jia, Xue

AU - Anzlovar, Nancy

AU - Bohne, Sue

AU - Fichera, Alessandro

AU - Aguilar, Debbie

AU - Mueller, Martha

AU - Riccardi, Rocco

AU - Bordeianou, Liliana

AU - Kunitake, Hiroko

AU - Antonelli, Donna

AU - Swierzewski, Kathy

AU - Devaney, Lynn

AU - Kin, Cindy

AU - Spain, David

AU - Hyke, Roxanne

AU - De Leon, Elmer

AU - Torbela, Aimee

AU - Keenan, Megan

AU - Goyette, Andrea

AU - Messaris, Evangelos

AU - Whyte, Richard

AU - Ward, Mary

AU - Beth Cotter, Mary

AU - Saraidaridis, Julia

AU - Lewis, W. David

AU - Sansone, Mary

AU - Crawford, Lynne

AU - Deutsch, Michael

AU - Scow, Jeffrey

AU - Huggins, Pam

AU - Shaffer, Virginia

AU - Sharma, Joe

AU - Sitafalwalla, Shamsah

AU - Smith, Radhika

AU - Mutch, Matthew

AU - Hall, Bruce

AU - Hirbe, Mitzi

AU - Batten, Joann

AU - Steinhagen, Randolph

AU - Khaitov, Sergey

AU - Sylla, Patricia

AU - Divino, Celia

AU - Miller, Reba

AU - Skowron Olortegui, Kinga

AU - Hyman, Neil

AU - Prachand, Vivek

AU - Sullivan, Sue

AU - Pullins, Lorice

AU - Barc, Carmen

AU - Hrabe, Jennifer

AU - Kapadia, Muneera

AU - Belding-Schmitt, Mary

AU - Yoo, James

AU - Goldberg, Joel

AU - Akinbami, Felix

AU - Steinberg, Jill

PY - 2024/1/1

Y1 - 2024/1/1

N2 - BACKGROUND: Patients with IBD are challenging to manage perioperatively because of disease complexity and multiple comorbidities. OBJECTIVE: To identify whether preoperative factors and operation type were associated with extended postoperative length of stay after IBD-related surgery, defined by 75th percentile or greater (n = 926; 30.8%). DESIGN: This was a cross-sectional study based on a retrospective multicenter database. SETTING: The National Surgery Quality Improvement Program-Inflammatory Bowel Disease Collaborative captured data from 15 high-volume sites. PATIENTS: A total of 3008 patients with IBD (1710 with Crohn's disease and 1291 with ulcerative colitis) with a median postoperative length of stay of 4 days (interquartile range, 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES: The primary outcome was extended postoperative length of stay. RESULTS: On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under receiver operating characteristic curve = 0.85). Clinically significant contributors that increased postoperative length of stay were rectal surgery (vs colon; OR, 2.13; 95% CI, 1.52-2.98), new ileostomy (vs no ileostomy; OR, 1.50; 95% CI, 1.15-1.97), preoperative hospitalization (OR, 13.45; 95% CI, 10.15-17.84), non-home discharge (OR, 4.78; 95% CI, 2.27-10.08), hypoalbuminemia (OR, 1.66; 95% CI, 1.27-2.18), and bleeding disorder (OR, 2.42; 95% CI, 1.22-4.82). LIMITATIONS: Retrospective review of only high-volume centers. CONCLUSIONS: Patients with IBD who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia, and ASA classes 3 to 5. Chronic corticosteroid, immunologic, small molecule, and biologic agent use were insignificant on multivariable analysis. See Video Abstract.

AB - BACKGROUND: Patients with IBD are challenging to manage perioperatively because of disease complexity and multiple comorbidities. OBJECTIVE: To identify whether preoperative factors and operation type were associated with extended postoperative length of stay after IBD-related surgery, defined by 75th percentile or greater (n = 926; 30.8%). DESIGN: This was a cross-sectional study based on a retrospective multicenter database. SETTING: The National Surgery Quality Improvement Program-Inflammatory Bowel Disease Collaborative captured data from 15 high-volume sites. PATIENTS: A total of 3008 patients with IBD (1710 with Crohn's disease and 1291 with ulcerative colitis) with a median postoperative length of stay of 4 days (interquartile range, 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES: The primary outcome was extended postoperative length of stay. RESULTS: On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under receiver operating characteristic curve = 0.85). Clinically significant contributors that increased postoperative length of stay were rectal surgery (vs colon; OR, 2.13; 95% CI, 1.52-2.98), new ileostomy (vs no ileostomy; OR, 1.50; 95% CI, 1.15-1.97), preoperative hospitalization (OR, 13.45; 95% CI, 10.15-17.84), non-home discharge (OR, 4.78; 95% CI, 2.27-10.08), hypoalbuminemia (OR, 1.66; 95% CI, 1.27-2.18), and bleeding disorder (OR, 2.42; 95% CI, 1.22-4.82). LIMITATIONS: Retrospective review of only high-volume centers. CONCLUSIONS: Patients with IBD who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia, and ASA classes 3 to 5. Chronic corticosteroid, immunologic, small molecule, and biologic agent use were insignificant on multivariable analysis. See Video Abstract.

KW - Crohn's disease

KW - Length of stay

KW - Perioperative course

KW - Postoperative complications

KW - Ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85179839814&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000002831

DO - 10.1097/DCR.0000000000002831

M3 - Article

C2 - 37410942

AN - SCOPUS:85179839814

SN - 0012-3706

VL - 67

SP - 97

EP - 106

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

IS - 1

ER -

Impact of Preoperative Factors in Patients with IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

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