Predictors of 30-Day Readmission & Reoperations Post Strictureplasty in Crohn’s Disease: A NSQIP Retrospective Review and Analysis

Abstract

INTRODUCTIONStrictureplasty, introduced in 1978, has been suggested as an alternative to small bowel resection for cases of intestinal obstruction involving multiple segments, such as in Crohn’s disease. Despite research supporting the operation, little is known about outcomes after strictureplasty. Specifically, 30-day readmission and reoperation rates, which are widely recognized as surrogates for quality of surgical care have not been studied for this procedure. We sought to study the rate of, as well as factors associated with 30-day outcomes, including readmission and reoperation.METHODSWe used the National Surgical Quality Improvement Program (NSQIP) participant user files (PUF) for the years 2012-2020. Primary Current Procedural Terminology (CPT) code “44615” was used to identify patients undergoing strictureplasty as their principal procedure. The outcomes of interest included related thirty-day readmissions and reoperations, non-routine discharge, and prolonged length of stay (LOS). Multivariable analyses were performed to identify factors associated with each outcome.RESULTSA total of 535 patients were identified with mean age 44.14 years (SD= 15.74). 52.5% were female. Thirty-day related readmission and reoperation rates were 9% (n=48) and 6% (n=32) respectively. Average LOS was 8.16 days (SD= 6.9). Non-routine discharge rate was4.2% (n=21). On multivariable logistic regression, factors associated with 30-day readmissions included longer operative time (OR 1.00, 95% CI 1.00-1.01, p=0.0008) and any surgical site infection (SSI) (OR 6.4, 95% CI 2.89-14.2, p<0.001). Increased LOS (OR 1.7, 95%CI 1.03-1.11, p=0.0009) and SSI (OR 28.1, 95%CI 10.44-75.47, p<0.001) were associated with 30-day related reoperation. Predictors of non-routine discharge included older age (65+ vs 18-40: OR 30.72, 95%CI 3.14-300.74, p=0.003) and longer LOS (OR 1.09, 95%CI 1.03-1.14, 0.0009). Factors associated with increased odds of prolonged LOS included higher ASA class (OR 3.29, 95%CI 2.10-5.14, p<0.001), longer operative time (1.00, 95%CI 1.00-1.01, p=0.0008) and SSI (OR 3.05, 95%CI 1.57-5.90, p=0.0009). Factors associated with lower odds of prolonged LOS included male sex (OR 0.56, 96%CI 0.36-0.88, p=0.011) and preoperative steroid use (OR 0.62, 95%CI 0.38-0.99, p=0.04).CONCLUSIONOur analyses indicate that among patients undergoing strictureplasty, longer operative time, wound complications, and longer length of stay are associated with increased odds of readmission and reoperation within 30 days. These findings may be important for hospitals, providers, payors, and other stakeholders in further refining standards of quality of care for patients undergoing strictureplasty.