EP370 - Design and Implementation of the American Society of Colon and Rectal Surgeons Quality Collaborative on Anal Fistula

ePoster Presenter(s)

• JS

  Julia Saraidaridis, MD

  Burlington, MA

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• BH

  Britany Hollenquest, BSPH

  Clinical Research Coordinator I
  Institute for Cancer Outcomes and Survivorship
  Birmingham, Alabama, United States

  Disclosure information not submitted.
• 

  Jonathan S. Abelson, MD MS (he/him/his)

  Staff Surgeon
  Lahey Hospital and Medical Center
  Tufts Medical Center
  Arlington, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AK

  Angela H. Kuhnen, MD, MPH (she/her/hers)

  Attending
  Lahey Hospital and Medical Center
  Tufts University School of Medicine
  Burlington, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Justin M. Greco, MB BCh (he/him/his)

  Assistant Professor of Surgery
  Loma Linda University Health
  Thomas Jefferson University
  Loma, CA, United States

  Disclosure information not submitted.
• 

  Jessica N. Cohan, MD, MAS, FACS, FASCRS (she/her/hers)

  Associate Professor of Surgery, Adjunct Assistant Professor of Population Health Sciences
  UNIVERSITY OF UTAH
  University of Utah and Huntsman Cancer Institute
  Salt Lake City, UT, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Haddon J. Pantel, MD

  Assistant Professor
  Yale School of Medicine
  Yale School of Medicine
  New Haven, CT, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Jennifer L. Paruch, MD (she/her/hers)

  Surgeon, Principal Investigator
  Ochsner Medical Center
  Ochsner Medical Center
  New Orleans, Louisiana, United States

  Disclosure information not submitted.
• MZ

  Matthew Zelhart, MD

  Vice Chair
  Ochsner Medical Center
  New Orleans, Louisiana, United States

  Disclosure information not submitted.
• JS

  Jeffrey S. Scow, MD, FACS, FASCRS

  Associate Professor of Surgery
  Milton S. Hershey Medical Center, Penn State Health
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• JV

  Jeffrey Van Eps, MD

  Associate Professor of Surgery
  UTHealth Science Center at Houston, McGovern Medical School
  Houston, Texas, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Robert Hollis, MD, MSPH

  Assistant Professor
  University of Alabama at Birmingham
  University of Alabama at Birmingham
  Birmingham, AL, United States

  Disclosure information not submitted.

Purpose/Background: Multiple national surgical quality collaboratives exist to improve the quality of surgical care; however, many exclude common colorectal surgery procedures. To address this gap, the American Society of Colon and Rectal Surgeons (ASCRS) prioritized the development of a quality collaborative focused on the optimization of care for colorectal surgery patients. Here we report the initial design and implementation of the quality collaborative focused on definitive anal fistula repair.

Methods/Interventions: The American Society of Colon and Rectal Surgery Quality Collaborative (ASCRS-QC) Working Group was formed with colorectal surgeon representatives from 10 institutions across the United States. Through an iterative process the working group determined data points surrounding definitive anal fistula repair including patient demographics, fistula characteristics, operative details, and fistula outcomes for inclusion. A prospective, multi-center registry of patients who underwent definitive anal fistula repair was created within the REDcap platform. A tableau dashboard was created for real-time feedback. Data collection was designed to occur at the time of definitive operative repair of the fistula, 90 days following surgery, and 180 days following surgery.

Results/Outcomes: From July 2024 to September 2025, the ASCRS-QC collected data regarding 108 consecutive anal fistula patients from 8 institutions and 12 participating surgeons. Types of repair included fistulotomy (n=49), Ligation of Intersphincteric Fistula Tract (LIFT; n=31), rectal advancement flap (n=21), cutting seton (n=6), and other (n=1). Patients had a median age of 44 years (IQR 36-52), 64.8% were male, 54.7% were white, and the median BMI was 29.0 (IQR 25.8-35.0). Patients had a mean duration of symptoms for 11 months (IQR 4-26) prior to definitive fistula repair. At the time of fistula repair, 61.1% had a seton in place, with most (74%) setons in place for >12 weeks prior to the repair. An MRI to guide fistula treatment was used in 23.1% of cases. Among the 97 patients with completed 3 month follow-up, surgeons reported 51% with complete healing of their fistula, 29.9% not healed, and 18.5% unsure of healing.

Conclusion/Discussion: The ASCRS-QC has been established as a platform for quality improvement of colorectal specific disease processes. Anal fistula is the first disease process to be explored. By development of this collaborative, ASCRS has facilitated creation of a framework for robust and collaborative data collection to provide real-time quality data to colon and rectal surgeons. With future growth of this registry, the ASCRS-QC is expected to serve as a useful means for ASCRS members to understand their own outcomes and to guide future best practices of surgical management of anal fistula. The ASCRS-QC is open for all ASCRS members to join, so please email us at qc@fascrs.org if you would like to be included.

Tableau Dashboard illustrating patient demographics of LIFT procedure