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

• Published in: The American journal of surgery 2024-11, Vol.237, p.115808, Article 115808
• Main Authors: Kane, William J., Kuron, Michael, Gooding, Jordan L., Hoang, Sook C., Friel, Charles M., Jin, Ruyun, Turrentine, Florence E., Hedrick, Traci L.
• Format: Article
• Language: English
• Subjects: Aged; Antibiotics; Colectomy; Colectomy - adverse effects; Colectomy - statistics & numerical data; Colectomy - trends; Colorectal surgery; Embolism; Enhanced recovery protocols; Female; Hospital costs; Humans; Laparoscopy; Length of stay; Length of Stay - statistics & numerical data; Male; Middle Aged; Minimally invasive surgery; Minimally Invasive Surgical Procedures - statistics & numerical data; Missing data; Morbidity; Mortality; Narcotics; Patients; Postoperative Complications - epidemiology; Postoperative period; Pulmonary embolisms; Quality control; Quality Improvement; Recovery (Medical); Regression analysis; Robotics; Statistical analysis; Surgery; Surgical anastomosis; Surgical site infection; Surgical site infections; Surgical Wound Infection - epidemiology; Thromboembolism; Treatment Outcome; Trends; United States - epidemiology; Venous thromboembolism
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115808

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. 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. 261,301 patients, 135,876 (52 ​%) female, with a median age of 62 (IQR 53–72) were included. Across all years, MIS partial colectomy was the most common procedure (37 ​%), followed by MIS low anterior resection (27 ​%), open partial colectomy (24 ​%), and open low anterior resection (12 ​%). MIS increased from 59 ​% in 2012–2014 to 66 ​% in 2018–2020 (p ​