Factors Affecting Textbook Outcomes for Colectomy for Diverticular Disease.

Area of Science:

• Colorectal Surgery
• Surgical Quality Improvement
• Health Services Research

Background:

• Textbook outcome (TO) is a validated metric for optimal surgical results, typically used in oncology.
• Its application and influencing factors in benign diseases like diverticular disease remain underexplored.
• This study investigates factors affecting TO in patients undergoing colectomy for diverticular disease.

Purpose of the Study:

• To identify patient and procedural factors associated with achieving textbook outcome (TO) in nonemergent colectomy for diverticular disease.
• To assess the feasibility of applying the TO metric to benign surgical conditions.
• To explore potential disparities in TO achievement.

Main Methods:

• Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database from 2015-2022.
• Inclusion of adult patients undergoing nonemergent colectomy for diverticular disease.
• TO defined by six criteria: no 30-day mortality, ≤8-day hospital stay, no ostomy, no 30-day reoperation, no 30-day readmission, and no adverse events.

Main Results:

• Out of 59,971 patients, 60.9% achieved TO. The most common reason for failure was hospital stay >8 days (22.1%).
• Younger age, lower ASA physical status, non-smoking status, mechanical bowel preparation, and oral antibiotic preparation were significantly associated with higher TO rates.
• Black patients had lower TO rates compared to White patients, requiring further investigation.

Conclusions:

• A substantial percentage of patients undergoing elective colectomy for diverticular disease do not achieve textbook outcome.
• Modifiable factors including smoking cessation and preoperative bowel preparation are linked to improved TO rates.
• Identified disparities among Black patients necessitate further research and targeted interventions.