Commentary regarding a baseline assessment of enhanced recovery protocol implementation at pediatric surgery practices performing inflammatory bowel disease surgeries

2020 ◽  
Vol 55 (10) ◽  
pp. 2007-2008
Author(s):  
Kurt Heiss
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pediatric Surgery ◽  
Enhanced Recovery ◽  
Baseline Assessment ◽  
Protocol Implementation ◽  
Enhanced Recovery Protocol ◽  
Inflammatory Bowel

Outcomes After Bowel Resection for Inflammatory Bowel Disease in the Era of Surgical Care Bundles and Enhanced Recovery

2019 ◽  
Vol 24 (1) ◽  
pp. 123-131 ◽  
Author(s):  
Anthony P. D’Andrea ◽  
Prerna Khetan ◽  
Reba Miller ◽  
Patricia Sylla ◽  
Celia M. Divino
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Bowel Resection ◽  
Enhanced Recovery ◽  
Surgical Care ◽  
Care Bundles ◽  
Inflammatory Bowel

Do Patients With Inflammatory Bowel Disease Benefit from an Enhanced Recovery Pathway?

2019 ◽  
Vol 26 (3) ◽  
pp. 476-483 ◽  
Author(s):  
David Liska ◽  
Turgut Bora Cengiz ◽  
Matteo Novello ◽  
Alexandra Aiello ◽  
Luca Stocchi ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Bowel Disease ◽  
Enhanced Recovery ◽  
Hospital Costs ◽  
Estimated Blood Loss ◽  
Enhanced Recovery Pathways ◽  
Inflammatory Bowel ◽  
Outpatient Operations ◽  
Recovery Pathways

Abstract Background Enhanced recovery pathways (ERPs) have been shown to reduce length of stay (LOS), complications, and costs after colorectal surgery; yet, little data exists regarding patients with inflammatory bowel disease (IBD). We hypothesized that implementation of ERP for IBD patients is associated with shorter LOS and improved economic outcomes. Methods An IRB-approved prospective clinical database was used to identify consecutive patients from 2015 to 2017. Patients were grouped as “pre-ERP” and “post-ERP” based on the date of implementation of a comprehensive ERP. Ileostomy closures, redo pouch operations, and outpatient operations were excluded. The relationship between ERP, LOS, and secondary outcomes was assessed using univariate and multivariate analysis. Results Overall, a total of 671 patients were included: 345 (51.4%) with Crohn’s disease (CD) and 326 (48.6%) with ulcerative colitis (UC). Of these, 425 were pre-ERP (63.4%), and 246 were post-ERP (36.6%). The groups did not differ in terms of age, gender, American Society of Anesthesiologist (ASA) scores, comorbidities, estimated blood loss, or ostomy construction. The post-ERP group had a significantly higher mean body mass index (BMI), more patients with CD, longer operative time, and more minimally invasive surgery (MIS; all P < 0.05). The post-ERP group had a significantly shorter LOS (6 vs 4.5 days, median), whereas mean hospital costs decreased by 15.7%. There was no difference in readmissions or complications. On multivariate analysis, MIS and ERP use were both associated with a shorter LOS. Conclusion Inflammatory bowel disease patients benefit from the use of ERP, demonstrating decreased LOS and costs without an increase in complications and readmissions. Enhanced recovery pathways should be routinely implemented in this often challenging patient population.

Do Patients with Inflammatory Bowel Disease Benefit from an Enhanced Recovery Pathway?

2018 ◽  
Vol 227 (4) ◽  
pp. e105
Author(s):  
David Liska ◽  
Turgut Bora Cengiz ◽  
Conor P. Delaney ◽  
Scott R. Steele ◽  
Tracy L. Hull ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Enhanced Recovery ◽  
Enhanced Recovery Pathway ◽  
Inflammatory Bowel

scholarly journals Applying Enhanced Recovery Pathways to Unique Patient Populations

2019 ◽  
Vol 32 (02) ◽  
pp. 134-137 ◽  
Author(s):  
Grace Lee ◽  
Richard Hodin
Keyword(s):  
Inflammatory Bowel Disease ◽  
Elderly Patients ◽  
Bowel Disease ◽  
Pediatric Patients ◽  
Enhanced Recovery ◽  
Similar Efficacy ◽  
Specific Patient ◽  
Enhanced Recovery Pathways ◽  
Inflammatory Bowel ◽  
Recovery Pathways

AbstractEnhanced Recovery after Surgery (ERAS) pathways have become popular in colorectal surgery due to their associated decrease in length of stay (LOS), complications, and readmission rate. However, it is unclear if these pathways are safe, feasible, or effective in unique patient populations such as elderly patients, urgent/emergent surgeries, patients with specific comorbidities, inflammatory bowel disease, or pediatric patients. Enhanced recovery pathways appear safe in elderly patients, associated with decreased complications, though with slightly lower rates of adherence and increased LOS and readmission rates. Modified ERAS pathways have been applied to urgent and emergent surgeries, resulting in decreased morbidity and LOS. There have been no studies that performed subgroup analyses of ERAS pathways in patients with specific comorbidities. Studies investigating patients with inflammatory bowel disease on enhanced recovery pathways are extremely limited, but suggest that they are safe and feasible. Data on ERAS pathways in pediatric patients are still emerging. Therefore, though data are sparse, enhanced recovery pathways appear to be safe in unique patient populations, with similar efficacy in decreasing LOS and complications. There is an urgent need for more studies investigating these specific patient groups to aid perioperative decision making by colorectal surgeons.

Impact of inflammatory bowel disease on urologic oncology surgical outcomes and costs of care.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 470-470
Author(s):  
Ilana Goldberg ◽  
Steven Lee Chang ◽  
Shilajit Kundu ◽  
Eric A. Singer
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Surgical Outcomes ◽  
Regression Models ◽  
Enhanced Recovery ◽  
Hospital Costs ◽  
Complication Rates ◽  
Readmission Rates ◽  
Urologic Oncology ◽  
Inflammatory Bowel

470 Background: Recent studies suggest an association between genitourinary malignancies and inflammatory bowel disease (IBD). Our objective was to investigate clinical and financial impacts of IBD on common major urologic cancer surgeries: radical prostatectomy (RP), radical cystectomy (RC), radical nephrectomy (RN), and partial nephrectomy (PN). Methods: Using ICD9 codes, the Premier Hospital Database was queried for patients who underwent one of four surgeries: RP, RC, RN, or PN from 2003 to 2015. The cohort was segregated into IBD patients and non-IBD patients. Multivariable logistic regression models were used to determine the independent impact of IBD on complication rates (by Clavien-Dindo classification and organ system) and readmission rates. Hospital cost differences between the two cohorts, adjusted to 2016 US dollars, were examined with multivariable quantile regression models. Results: Our study population included 220,192 patients with urological malignancies, 5165 (0.4%) of whom had IBD. After controlling for clinicodemographic variables, there were significantly higher odds for any complication (Clavien ≥1) for IBD patients compared to non-IBD controls for RC (Odds ratio [OR]: 3.04, 95% confidence interval [CI]: 1.25-7.43), RN (OR: 1.57, 95% CI: 1.1-2.23), and PN (OR: 1.5, 95% CI: 1.02-2.22). Specifically, IBD patients had significantly more gastrointestinal, infectious, and soft tissue complications. Readmission rates were significantly higher for IBD patients who underwent RC (OR: 2.50, 95% CI: 1.17-5.35) and PN (OR: 1.81, 95% CI: 1.17-2.80). Hospital costs were significantly elevated for IBD patients, ranging from +$893 (95% CI: 108-1677) to +$6261 (95% CI: 1861-10660). Conclusions: There was a significantly higher overall complication rate for IBD patients undergoing RC, RN, or PN compared to the non-IBD cohort. Hospital readmission rates were significantly higher for the IBD cohort who underwent RC and PN. Hospital costs associated with surgery were also increased for IBD patients. These findings may be important when counseling IBD patients about surgical outcomes and during development of enhanced recovery pathways or bundled payment programs.

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