Skip to main content
Journal cover image

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.

Publication ,  Journal Article
Keenan, JE; Speicher, PJ; Nussbaum, DP; Adam, MA; Miller, TE; Mantyh, CR; Thacker, JKM
Published in: J Am Coll Surg
August 2015

BACKGROUND: The purpose of this study was to examine the impact of the sequential implementation of the enhanced recovery program (ERP) and surgical site infection bundle (SSIB) on short-term outcomes in colorectal surgery (CRS) to determine if the presence of multiple standardized care programs provides additive benefit. STUDY DESIGN: Institutional ACS-NSQIP data were used to identify patients who underwent elective CRS from September 2006 to March 2013. The cohort was stratified into 3 groups relative to implementation of the ERP (February 1, 2010) and SSIB (July 1, 2011). Unadjusted characteristics and 30-day outcomes were assessed, and inverse proportional weighting was then used to determine the adjusted effect of these programs. RESULTS: There were 787 patients included: 337, 165, and 285 in the pre-ERP/SSIB, post-ERP/pre-SSIB, and post-ERP/SSIB periods, respectively. After inverse probability weighting (IPW) adjustment, groups were balanced with respect to patient and procedural characteristics considered. Compared with the pre-ERP/SSIB group, the post-ERP/pre-SSIB group had significantly reduced length of hospitalization (8.3 vs 6.6 days, p = 0.01) but did not differ with respect to postoperative wound complications and sepsis. Subsequent introduction of the SSIB then resulted in a significant decrease in superficial SSI (16.1% vs 6.3%, p < 0.01) and postoperative sepsis (11.2% vs 1.8%, p < 0.01). Finally, inflation-adjusted mean hospital cost for a CRS admission fell from $31,926 in 2008 to $22,044 in 2013 (p < 0.01). CONCLUSIONS: Sequential implementation of the ERP and SSIB provided incremental improvements in CRS outcomes while controlling hospital costs, supporting their combined use as an effective strategy toward improving the quality of patient care.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

August 2015

Volume

221

Issue

2

Start / End Page

404 / 14.e1

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Quality Improvement
  • Perioperative Care
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Keenan, J. E., Speicher, P. J., Nussbaum, D. P., Adam, M. A., Miller, T. E., Mantyh, C. R., & Thacker, J. K. M. (2015). Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs. J Am Coll Surg, 221(2), 404-14.e1. https://doi.org/10.1016/j.jamcollsurg.2015.04.008
Keenan, Jeffrey E., Paul J. Speicher, Daniel P. Nussbaum, Mohamed Abdelgadir Adam, Timothy E. Miller, Christopher R. Mantyh, and Julie K. M. Thacker. “Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.J Am Coll Surg 221, no. 2 (August 2015): 404-14.e1. https://doi.org/10.1016/j.jamcollsurg.2015.04.008.
Keenan JE, Speicher PJ, Nussbaum DP, Adam MA, Miller TE, Mantyh CR, et al. Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs. J Am Coll Surg. 2015 Aug;221(2):404-14.e1.
Keenan, Jeffrey E., et al. “Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.J Am Coll Surg, vol. 221, no. 2, Aug. 2015, pp. 404-14.e1. Pubmed, doi:10.1016/j.jamcollsurg.2015.04.008.
Keenan JE, Speicher PJ, Nussbaum DP, Adam MA, Miller TE, Mantyh CR, Thacker JKM. Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs. J Am Coll Surg. 2015 Aug;221(2):404–14.e1.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

August 2015

Volume

221

Issue

2

Start / End Page

404 / 14.e1

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Quality Improvement
  • Perioperative Care
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Humans
  • Female