EP528 - Predictors of Non-Textbook Colectomy Among Patients in the National ACS-NSQIP Database

Sunday, May 11, 2025

2:57 PM – 3:02 PM PT

Location: Monitor 9, Sails Pavilion, Upper Level

ePoster Presenter(s)

Jennifer G. Pierce, MD, MPH

Colorectal Surgery Fellow
University of Kentucky
Lexington, Kentucky, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

DD

Daniel Davenport, PhD

Professor
University of Kentucky
Lexington, Kentucky, United States

Disclosure information not submitted.
LB

Lance Butler, BA

Research Assistant
University of Kentucky
Lexington, Kentucky, United States

Disclosure information not submitted.
Meredith L. Johnson, MD (she/her/hers)

Resident
University of Kentucky
Lexington, KY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
BL

Brittany Levy, MD MPH

Resident
University of Kentucky
Lexington, KY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
EW

Erin Wolf Horrell, MD, PhD

Assistant Professor
University of Kentucky
Lexington, Kentucky, United States

Disclosure information not submitted.

Senior Author(s)

Jitesh A. Patel, MD, MBA

Professor of Surgery
University of Kentucky
University of Kentucky
Lexington, KY, US

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Jennifer G. Pierce, MD, MPH: This individual has no financial relationships with ineligible companies.

Meredith L. Johnson, MD: This individual has no financial relationships with ineligible companies.

Brittany Levy, MD MPH: This individual has no financial relationships with ineligible companies.

Jitesh A. Patel, MD, MBA: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Textbook outcome (TO) is a composite measure defined to capture the all-or-none “ideal” post-operative course. Further study is needed to characterize drivers of variation in textbook outcome with more granularity to understand its utility as a national benchmark for quality performance in colorectal surgery. This study aimed to evaluate the impact of perioperative risk factors on failure to achieve a TO (i.e., a non-TO), among patients who underwent colectomy from the national American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) public use files. In addition to standard NSQIP risk predictors, we analyzed the influence of transfers and urgent cases.

Methods/Interventions: This retrospective cohort study included patients from the ACS-NSQIP dataset undergoing elective or urgent colectomy between January 2021 and December 2022. Non-textbook outcome was defined as the presence of any of the following adverse post-operative outcomes: 30-day mortality, return to the hospital, return to the operating room (OR), any NSQIP complication, and length of stay (LOS) > 6 days (75th percentile of the cohort). The odds ratios for non-TO with multivariable adjustment were calculated.

Results/Outcomes: Among 77,032 patients undergoing colectomy, 30-day mortality rate was 1.3%, 8.8% returned to the hospital, 4.3% returned to OR, 18.2% had 1+ NSQIP complication, and 37.8% had LOS >6 days, with a total of 40.6% of patients (n = 31,646) with a non-TO. All risk variables, including transfer and urgent case status, were independently associated with increased odds of non-TO with statistical significance (P < 0.01). Patient characteristics, operative factors, and risk variables with the largest odds ratios after adjusting for all other factors (i.e., those with aOR > 1.5) are outlined in Table 1.

Conclusion/Discussion: Using ACS-NSQIP data, this study reports that all NSQIP risk variables in addition to transfer from outside facility and urgent case status predict non-textbook outcome of colectomy. It is possible that textbook outcome should be used with caution as a national quality metric for colectomy as it may require very comprehensive risk adjustment to make valid between-hospital comparisons and avoid the interpretation that textbook outcomes are best achievable through operating on “ideal” patients without perioperative risk.