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 journalArticlepeer-review

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 languageEnglish
Pages (from-to)97-106
Number of pages10
JournalDiseases of the Colon and Rectum
Volume67
Issue number1
DOIs
StatePublished - 1 Jan 2024

Keywords

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

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