The ACS National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative: Design,...

Area of Science:

• Surgical Quality Improvement
• Inflammatory Bowel Disease Research
• Multicenter Data Collection

Background:

• Surgery for inflammatory bowel disease (IBD) presents complex challenges and risks of postoperative complications.
• Existing surgical best practices often lack robust multicenter clinical data.
• The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) offers a platform for large-volume surgical outcomes data.

Purpose of the Study:

• To utilize the ACS-NSQIP to collect crucial disease-specific variables for surgical outcomes in IBD patients.
• To establish a multicenter collaborative for enhancing IBD surgical data collection.
• To validate the reliability of newly incorporated IBD-specific variables within the NSQIP database.

Main Methods:

• A collaborative of 13 high-volume IBD surgery centers was formed to collect five IBD-specific variables in NSQIP.
• Collected variables included medication usage (biologics, immunomodulators), ileostomy rates, ileal pouch anastomotic techniques, and colonic dysplasia/neoplasia.
• Data validation involved kappa agreement statistics between surgical clinical reviewers and colorectal surgeons.

Main Results:

• Data from 956 cases were collected over one year, with 41.4% of patients having used biologics pre-surgery.
• Common procedures included laparoscopic ileocolic resections and subtotal colectomies; 56.8% of cases involved an ileostomy.
• Validation confirmed reliable collection of all five novel variables, with excellent agreement (kappa ≥ 0.70) for four and very good agreement (kappa = 0.68) for colonic dysplasia.

Conclusions:

• The initial year of this disease-specific collaborative within NSQIP demonstrated reliable collection of key IBD surgical variables.
• This initiative establishes a foundation for high-quality, large-volume research tailored to the IBD patient population.
• The successful implementation paves the way for improved understanding and management of surgical outcomes in IBD.