Have outcomes following colectomy in the United States improved over time?

ABSTRACT

BACKGROUND: There has been tremendous effort to improve quality following colorectal surgery, including the proliferation of minimally invasive techniques, enhanced recovery protocols, and surgical site infection prevention bundles. While these programs have demonstrated improved postoperative outcomes at the institutional level, it is unclear whether similar benefits are present on a national scale. METHODS: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Targeted Colectomy data from 2012 to 2020 were used to identify patients undergoing minimally invasive surgery (MIS) or open partial colectomy (CPT 44140, 44204) or low anterior resection (CPT 44145, 44207). Chronological cohorts as well as annual trends in 30-day postoperative outcomes including surgical site infection, venous thromboembolism, and length of stay were assessed using both univariable and multivariable regression analyses. RESULTS: 261,301 patients, 135,876 (52 â€‹%) female, with a median age of 62 (IQR 53-72) were included. Across all years, MIS partial colectomy was the most common procedure (37 â€‹%), followed by MIS low anterior resection (27 â€‹%), open partial colectomy (24 â€‹%), and open low anterior resection (12 â€‹%). MIS increased from 59 â€‹% in 2012-2014 to 66 â€‹% in 2018-2020 (p â€‹< â€‹0.001). During this same period, postoperative length of stay decreased from a median of 5 days (IQR 4-7) in 2012-2014 to 4 days (IQR 3-6) in 2018-2020 (p â€‹< â€‹0.001). Superficial surgical site infections decreased from 5.5 â€‹% in 2012-2014 to 2.9 â€‹% in 2018-2020 (p â€‹< â€‹0.001). Deep surgical site infections similarly decreased from 1.1 â€‹% to 0.4 â€‹% between these periods (p â€‹< â€‹0.001). Pulmonary embolism also decreased from 0.6 â€‹% to 0.5 â€‹% between periods (p â€‹= â€‹0.02). 30-day mortality was unchanged at 1.7 â€‹% between 2012-2014 and 2018-2020 (p â€‹= â€‹0.40). After adjustment for ACS NSQIP estimated probability of morbidity and mortality, undergoing a colectomy in 2020 compared to 2012 was associated with a 14 â€‹% decrease in postoperative length of stay (p â€‹< â€‹0.001). CONCLUSIONS: Between 2012 and 2020, significant improvements in postoperative outcomes after colectomy were observed in the United States. These results support the positive impact that the widespread adoption of quality improvement initiatives is having on colorectal patient care nationally.