W. Y. Luo1, S. Eisenstein2 1University Of California – San Diego,School Of Medicine,San Diego, CA, USA 2University Of California – San Diego,School Of Medicine, Department Of Surgery, Division Of Colon & Rectal Surgery,San Diego, CA, USA
Presented on behalf of the the NSQIP-IBD Collaborative.
Introduction:
Restorative proctocolectomy with ileal pouch anal anastomosis (RPC-IPAA) is a popular method of resecting the colon and rectum for refractory ulcerative colitis (UC). RPC-IPAA can be staged to help mitigate the risk of complications in patients who are already high risk.
The American College of Surgeons' (ACS) National Surgical Quality Improvement Program (NSQIP) uses Current Procedural Terminology (CPT) codes to record procedures. This fails to capture whether diverting ileostomies (IS) are created during RPC-IPAA, and makes distinguishing between staged approaches difficult.
Methods:
Retrospective review was performed on surgically managed IBD patients from NSQIP across 11 sites in the US from March 2017 to March 2019 to form the NSQIP-IBD Collaborative database. Baseline data were gathered, with CPT codes, IS/IPAA formation, and anastomotic technique (AT). RPC-IPAA staged approach definitions are shown in Table 1. To compare the granularity of our data against NSQIP data, we queried secondary procedures for the same cases as coded in NSQIP for IS formation via CPT codes 44310, 44312, 44314, 44316, and 44187.
Results:
Of 2811 IBD patients, 827 patients with UC underwent surgery. 260 patients underwent RPC-IPAA. Average age of these patients was 38.8±14.0 years. 150 (57.7%) were male, 55 (21.1%) had steroid use, 10 (3.8%) had immune modulator use, and 35 (13.5%) had biologic use. Average BMI was 25.4±5.0. Average ASA class was 2.4±0.5. Based on Table 1, 3 (1.2%) had 1-stage, 73 (28.1%) had classical 2-stage, 3 (1.2%) had modified 2-stage, and 181 (69.6%) had 3-stage RPC-IPAA. 215 (82.7%) IPAAs were formed via double-staple technique, 1 (0.4%) was hand sewn without mucosectomy, and 9 (3.5%) were hand sewn with mucosectomy. The remaining cases were missing data on AT.
Of the 260 patients, 254 (97.5%) underwent IS. Query of secondary procedures from NSQIP showed that only 2 (0.8%) of the 260 patients had recorded IS formation via CPT coding.
Conclusion:
Our database allows capture of IBD surgeries in greater detail than what is currently available in NSQIP. There is also a paucity of IS data currently available in the NSQIP database compared to our database. Identification of anastamotic technique offers further detail. The increased data granularity collected for UC patients allows us to apply more robust analyses to a population that relies on surgery for curative treatment and is a model for NSQIP surgical data collection.
