A.L. Kennalley1, S. Wang2, M.A. Awad4, A. Matthai4, R. Hoffman5, J. Blansfield3 4Geisinger Medical Center, Surgery Residency, Danville, PA, USA 5Geisinger Medical Center, Colorectal Surgery, Danville, PA, USA 1Geisinger Commonwealth School of Medicine, Scranton, PA, USA 2Geisinger Health System, Department Of Population Health Sciences, Danville, PA, USA 3Geisinger Medical Center, Surgical Oncology, Danville, PA, USA
Introduction:
Textbook outcome (TO) is a composite measure representing the most favorable patient outcome. TO is a validated quality metric for various oncological operations across hospitals. TO is achieved when all criteria are met, offering a broader quality metric than comparing individual outcomes. However, limited research exists on TO for non-oncologic surgeries. The main objective of this study was to identify factors influencing achievement of TO in patients undergoing non-emergent colectomy for diverticular disease.
Methods:
A retrospective review of the National Surgical Quality Improvement Program from 2015 to 2022 was conducted, focusing on adult patients undergoing non-emergent colectomy for diverticular disease. TO was defined as achievement of six separate outcomes: (1) no 30-day mortality, (2) hospital stay of 8 days or less, (3) no ostomy placement, (4) no 30-day reoperation, (5) no 30-day readmission, and (6) no adverse events.
Results:
This study included 59,971 patients. Of these, 36,568 patients (60.9%) achieved TO. The median age was 60, and 56% were female. The most common reason for not achieving a TO was length of hospital stay greater than eight days (22.1%).
Multiple factors influenced TO. On multivariate analysis, TO was significantly associated with younger age (OR: 0.986, 95% CI:0.985-0.988, p<0.0001). Black patients were significantly less likely to receive TO compared to White patients (OR: 0.618, 95% CI:0.571-0.668). Lower ASA class was associated with significantly more TOs as was non-smoking history (OR: 0.664, 95% CI:0.630-0.699, p<0.0001). TO was also associated with mechanical bowel preparation (OR: 2.8, 95% CI:2.659-2.95, p<0.0001), and oral antibiotic preparation (OR: 1.868, 95% CI:1.777-1.964, p<0.0001).
Conclusion:
A significant proportion of patients undergoing elective colectomy for diverticular disease do not achieve TO. Modifiable factors such as smoking cessation and preoperative bowel preparation can improve TO rates. Additionally, significant disparities in achieving TO among Black patients underscore the need for targeted interventions to address healthcare inequities.