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Using NSQIP and Zynxhealth to Build and Assess a Fast Track Colon
Surgery Program
Gary, M DO; Carr, S, RN; West, E MA; Joseph, C MPH; Tutela, S BSN;
Counihan, T MD
Berkshire Medical Center, Department of Surgery Pittsfield, MA
Introduction: A fast track colon surgery program was initiated in July 2009 at our
institution using an evidence based decision support system. Quality
improvement efforts required the measurement of results of our new program.
Methods: Our program was built by a multidisciplinary team using clinical
decision support and standardized order sets from Zynxhealth. The National
Surgical Quality Improvement Program (NSQIP) database was used to identify
patients undergoing elective colon surgery prior to the fast track program
(8/1/2006-1/31/2009) and following implementation of the program (6/1/2009-
9/30/2012). Data were compared using two sample % defective and standard
deviation tests.
Results: There were 69 patients available for analysis undergoing traditional
care and 157 patients underwent surgery using the fast track program. The mean
age was 63.6 (63% female) in the fast track group and 66.1 (55% female) in the
traditional group. The patients in both groups were similar in terms of race,
ethnicity, body mass index, co-morbid conditions and ASA status. There was one
death in the traditional group. Common complications and length of stay are
shown in Table 1.
Table 1. Outcomes for fast track versus traditional colectomy
Overall
complications*
p=0.036
Respiratory
complications*
p=0.004
Urinary tract
complications*
p=0.037
Wound
occurrences*
p=0.85
Length of
stay†
p=0.030
Tradition 26 (37.6%) 11 (15.9%) 7 (10%) 12(17.4%) 8.9
al (n=69)
Fast 37 (23.5%) 6 (3.8%) 4 (2.5%) 26 (16.3%) 5.4
track
(n=157)
* using two sample % defective test
† using two sample standard deviation test
Conclusion: Implementation of our fast track colon surgery program resulted in
a reduction in length of stay, urinary tract complications, respiratory
complications and overall postoperative occurrences. NSQIP provided accurate
data to assess the results of our program. The combination of a clinical decision
support system (Zynxhealth) and NSQIP allowed accurate assessment of rapid
improvement in colon surgery patients at our institution.