Colorectal Surgery: Ischemic Colitis is Highest Risk

Colorectal surgery is very common in the United States, and readmission because of complications has been a challenge for surgeons.

These surgeries address colorectal cancer, ulcerative colitis, Crohn's disease, mechanical bowel obstruction and recurrent diverticulitis. Considered "dirty" surgery, major reconstruction of the gastrointestinal tract is often a necessity.

With all types of insurers beginning to integrate postoperative (PO) outcomes into value-based purchasing programs, hospitals are wary of the proposed penalties they may incur if patients are readmitted. This has created a research impetus.

A group of investigators from Stanford School of Medicine in Palo Alto, CA, recently assessed adverse events in colorectal surgical patients. Using 4 years of data from the Nationwide Inpatient Sample database, they identified 1,100,184 colorectal patients who underwent major surgery. They searched for inpatient adverse event identified by Agency for Healthcare Research and Quality’s patient safety indicators (PSIs).

Among these patients, 2.7% developed PSI during their hospital stays.

The researchers noted that patients who had surgery for ischemic colitis were at significantly elevated risks of pressure ulcer, failure to rescue, central line bloodstream infection, embolism/deep vein thrombosis, and sepsis.

Patients with ischemic colitis were 1.84 times more likely to develop a PO than cancer patients. The investigators attributed the high risk to ischemic colitis's associations with vascular compromise of the colonic mucosa and resulting immune barrier function compromise.

Patients who underwent procedures for benign polyps were at lowest risk for POs.

Although increasing age, black race, and public insurance (e.g. Medicare and Medicaid) were associated with increases risk of adverse event, patient demographic and clinical characteristics were significantly less reliable predictors of PO than procedure indication or diagnostic category.

Surgeons and their teams have worked hard to reduce the rate of adverse event in colorectal surgery, but adverse events continue to be common. These investigators promoted the need for rigorous risk adjustment and quality improvement strategies for high-risk populations. They also recommended that insurers needed to pay attention to detail when they design financial incentives and penalties for colorectal surgery.