ACS NSQIP-IBD Collaborative

Purpose: While many patients will have their IBD diagnosis as the preop diagnosis for surgery, some may have cancer or bowel obstruction listed instead. This variable allows analysis independent of ICD-10 coding.

Response options:

• a. Crohn’s Disease (K50.*)
• b. Ulcerative Colitis (K51.*)
• c. Indeterminate Colitis / IBD-NOS (K52.3)

Tip: For patients with multiple IBD diagnoses in the chart, use the “postop diagnosis” from the operative report.

Where to find: Operative report, preop H&P, anesthesia record.

Purpose: Was the patient on a biologic agent at any point over the 60-day period prior to surgery? This includes but is not limited to the agents listed below.

Note: BioMed is captured as two variables: (1) a Yes/No exposure flag, and (2) the specific agent used.

Response options: No • Yes • Unable to determine

Tracked agents (15+):

• Anti-TNF: Infliximab (Remicade), Adalimumab (Humira), Certolizumab (Cimzia), Golimumab (Simponi), Infliximab-dyyb (Inflectra), Infliximab-abda (Renflexis)
• Anti-integrin: Vedolizumab (Entyvio), Natalizumab (Tysabri)
• Anti-IL-12/23: Ustekinumab (Stelara), Risankizumab (Skyrizi), Guselkumab (Tremfya)
• JAK inhibitors: Tofacitinib (Xeljanz), Upadacitinib (Rinvoq)
• S1P modulators: Ozanimod (Zeposia), Etrasimod (Velsipity)

Where to find: Medication reconciliation, preop clinic notes, infusion center records.

Purpose: Was the patient taking immunomodulation therapy at any point over the 60-day period prior to surgery?

Note: ImmMod is captured as two variables: (1) a Yes/No exposure flag, and (2) the specific agent used.

Response options: No • Yes • Unable to determine

Agents included:

• 6-Mercaptopurine (6-MP, Purinethol, Purixan)
• Azathioprine (Imuran, AZA)
• Methotrexate (MTX, Trexall, Rasuvo, Folex PFS)

Note: Unlike biologics, there are few new thiopurines entering the market. This list should remain fairly static.

Where to find: Medication reconciliation, preop clinic notes, pharmacy records.

Purpose: Several CPT codes for IBD surgery include “with or without ileostomy.” This variable clarifies the patient’s ileostomy status at the end of the procedure.

Response options (5 categories):

• a. None: No ileostomy
• b. New ileostomy: Patient did not have an ileostomy prior to surgery and completed surgery with one
• c. Ileostomy from prior is unaltered: Patient had an ileostomy prior to surgery which remained unaltered after
• d. Conversion of end ileostomy to loop: Patient had an end ileostomy prior to surgery and had formation of a loop ileostomy during
• e. Other ileostomy revision: All other ileostomy transitions

Tip: Conversion from end to loop is common in completion proctectomy with IPAA after prior subtotal colectomy.

Where to find: Operative report (body text and procedure list).

Purpose: For patients undergoing proctectomy, was an ileal pouch-anal anastomosis (IPAA) created during this surgery?

Response options: Yes • No • Not applicable

Applicable CPT codes: 45113, 44158, 44211, 45397

Note: This includes any configuration (J-pouch and S-pouch). CPT 45397 is often used as a surrogate for laparoscopic or robotic completion proctectomy with IPAA, even though its formal definition covers partial proctectomy with colonic J-pouch. This variable helps identify which of these cases are actually IPAAs.

Purpose: Presence and grade of colonic dysplasia or neoplasia at the time of surgery. This is an important surgical indication that is not captured in standard NSQIP.

Response options (4 categories):

• a. None
• b. Low-grade dysplasia
• c. High-grade dysplasia
• d. Cancer

Where to find: Preoperative colonoscopy/pathology reports, operative report.

Purpose: Single variable that applies to all IBD surgeries involving anastomosis (replaces the retired IPAA Technique variable). Captures anastomosis configuration/construction method, and staple line reinforcement.

Construction methods:

• Stapled side-to-side (functional end-to-end): Linear stapler anastomosis. Common in ileocolic resections and small-bowel.
• Stapled end-to-end (circular): Circular stapler (EEA, echelon circular, DST). Look for “anvil” or “spike” in the operative report. Common in IPAA, coloproctostomy, ileoproctostomy, colorectal anastomoses.
• Stapled end-to-side: Circular stapler with end of one limb to side of the other.
• Stapled side-to-end: Side of proximal bowel to end of distal bowel.
• Hand-sewn end-to-end: Fully hand-sewn, end-to-end anastomosis.
• Hand-sewn side-to-side: Fully hand-sewn side-to-side anastomosis.
• Hand-sewn end-to-side / side-to-end: Fully hand-sewn end-to-side or side-to-end.
• Mucosectomy with hand-sewn ileoanal: Mucosal sleeve dissected to dentate line, pouch hand-sewn to anal canal. Only in IPAA.
• Kono-S: Antimesenteric, functional end-to-end with supporting column.
• Other / combined technique: Anything not captured above.
• None / not applicable: No anastomosis created.

Staple line reinforcement: Captured as a separate sub-element (yes/no + material, e.g., buttress, suture oversew).

Where to find: Operative report — detailed description of anastomosis technique.

Step-by-step process for extracting deidentified data from the NSQIP Resource Portal:

• 1. Log in to the ACS NSQIP Resource Portal
• 2. Navigate to Data Reports → Custom Export
• 3. Filter by ICD-10 codes: K50.* (Crohn’s), K51.* (UC), K52.3 (Indeterminate)
• 4. Include all subcategories and subdiagnoses within these roots
• 5. Select all IBD-specific variables + standard NSQIP fields
• 6. Export to Excel
• 7. Remove all patient identifier columns (name, MRN, DOB, SSN, etc.)
• 8. Verify no identifiable information remains
• 9. Save deidentified Excel file and submit via secure upload to the collaborative coordinator

Submit to: the collaborative coordinator (see contact info below)