title: Colectomy performance improvement within NSQIP 2005-2008.
abstract: BACKGROUND
  All open and laparoscopic colectomies submitted to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were evaluated for trends and improvements in operative outcomes.
  
  
  METHODS
  48,247 adults (≥18 y old) underwent colectomy in ACS NSQIP, as grouped by surgical approach (laparoscopic versus open), urgency (emergent versus elective), and operative year (2005 to 2008). Primary outcomes measured morbidity, mortality, perioperative, and postoperative complications.
  
  
  RESULTS
  The proportion of laparoscopic colectomies performed increased annually (26.3% to 34.0%), while open colectomies decreased (73.7% to 66.0%; P < 0.0001). Most emergent colectomies were open procedures (93.5%) representing 24.3% of all open cases. The overall risk-adjusted morbidity and mortality for all colectomy procedures did not show a statistically significant change over time, however, morbidity and mortality increased among open colectomies (r = 0.03) and decreased among laparoscopic colectomies (r = -0.04; P < 0.0001). Postoperative complications reduced significantly including superficial surgical site infections (9.17% to 8.20%, P < 0.004), pneumonia (4.60% to 3.97%, P < 0.0001), and sepsis (4.72%, 2005; 6.81%, 2006; 5.62%, 2007; 5.09%, 2008; P < 0.0002). Perioperative improvements included operative time (169.2 to 160.0 min), PRBC transfusions (0.27 to 0.25 units) and length of stay (10.5 to 6.61 d; P < 0.0001).
  
  
  CONCLUSIONS
  It appears that laparoscopic colectomies are growing in popularity over open colectomies, but the need for emergent open procedures remains unchanged. Across all colectomies, however, key postoperative and perioperative complications have improved over time. Participation in ACS NSQIP demonstrates quality improvement and may encourage greater enrollment.
authors.affiliation: Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Ozhathil
authors.forename: YouFu
authors.initials: Y
authors.lastname: Li
authors.forename: Jillian K
authors.initials: JK
authors.lastname: Smith
authors.forename: Elan
authors.initials: E
authors.lastname: Witkowski
authors.forename: Elizaveta Ragulin
authors.initials: ER
authors.lastname: Coyne
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality / Q000592:standards*; D016208:Databases, Factual / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000401:mortality / Q000592:standards*; D004638:Emergency Treatment / Q000401:mortality / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult