P0871 Textbook Outcomes in Acute Severe Ulcerative Colitis: A Novel Approach to Assessing Patient Quality of Care in Inflammatory Bowel Disease
Authors: Wu M Y , Nario S , Tung C , Kiely C 
Published: January 2025

Background

Textbook outcome (TBO) is a concept of quality performance measurement that has garnered traction in the medical and surgical field. While traditional methods evaluate individual outcome parameters, TBO is a composite measurement of key performance indicators and is only achieved when all individual criteria are met. Studies suggest that a composite TBO provides a superior holistic assessment of patient outcomes, better captures the multidimensional aspects of patient care and sets a comparable benchmark for quality improvement across treatment centres.1,2 To date, a TBO has not been defined or utilised in the setting of acute severe ulcerative colitis (ASUC). We aimed to define a TBO using guideline-based standards of care for ASUC presentations and assessed whether TBO was associated with improved treatment outcomes.3

Methods

All ASUC presentations to a Quaternary Sydney hospital over a 10-year period were included. A modified True-love Witts’ Criteria was used to identify ASUC as ≥6 bloody bowel motions daily and presence of at least one systemic feature, including heart rate &gt;90 bpm, temperature &gt;37.8°C, haemoglobin &lt;105 g/L, and C-reactive protein (CRP) ≥30 mg/L.4 We defined achievement of TBO as IV steroids and venous thromboembolism prophylaxis (VTEp) commenced on admission, stool samples to exclude infective pathogens, including C. difficile, abdominal imaging completed within 24 hours from presentation, and flexible sigmoidoscopy completed within 48 hours from presentation. Treatment outcomes measured were rates of rescue therapy, colectomy, length of stay, 30-day and 90-day readmission.

Results

During the study period, 172 presentations met criteria for ASUC and of these, 14.0% (n=24) admissions achieved a TBO. The number of presentations meeting each TBO criteria is shown Figure 1. Stool sample screening (91.3%), IV steroids (79.1%) and VTEp (73.3%) on admission were the most frequently achieved parameters. The least frequently achieved parameter was timely flexible sigmoidoscopy within 48 hours of presentation (36.0%). A comparison of outcomes for patients achieving TBO compared to those without a TBO is shown in Table 1. Achieving a TBO was associated with significantly shorter length of stay.

Conclusion

Composite outcome measures, such as TBO, have become a popular metric of comparing and benchmarking standards of care. ASUC patients who achieved a TBO, defined by meeting five guideline-based criteria as part of their initial investigations and management, were found to have a significantly shorter length of stay. There were no differences in need for rescue therapy, colectomy and readmission rate. More research is required to refine the consensus parameters that encompass a TBO in ASUC presentations.

References

1.Naumann DN, Bhangu A, Brooks A, et al. A call for patient-centred textbook outcomes for emergency surgery and trauma. Br J Surg. 2022;109(12):1191. doi:10.1093/BJS/ZNAC271

2.Tsilimigras DI, Pawlik TM, Moris D. Textbook outcomes in hepatobiliary and pancreatic surgery. World J Gastroenterol. 2021;27(15):1524. doi:10.3748/WJG.V27.I15.1524

3.Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/GUTJNL-2019-318484

4.Sturm A, Maaser C, Calabrese E, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis. 2019;13(3):273-284. doi:10.1093/ECCO-JCC/JJY114