58 – Outcomes After Implementation of a Surgical Care Bundle for Colectomy Followed by Enhanced Recovery Protocol for Patients with Inflammatory Bowel Disease Undergoing Colorectal Resection

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.

Download Full-text

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

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.08.283 ◽

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

Download Full-text

Correction to: Comparison of outcome after right colectomy with an enhanced recovery programme in patients with inflammatory bowel disease and patients operated on for other conditions: a monocentric retrospective study

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03853-6 ◽

2021 ◽

Author(s):

Anne Meunier ◽

Giuseppe Sorce ◽

Pierre-Yves Hardy ◽

Carla Coimbra ◽

Emmanuel Decker ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Retrospective Study ◽

Bowel Disease ◽

Enhanced Recovery ◽

Right Colectomy ◽

Enhanced Recovery Programme ◽

Inflammatory Bowel

Download Full-text

Development and Evaluation of a Transition Model for Adolescents With Inflammatory Bowel Disease Moving From Pediatric to Adult Surgical Care

Journal of Pediatric Surgical Nursing ◽

10.1097/jps.0000000000000323 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jenny Bergström ◽

Michaela Dellenmark-Blom ◽

Vladimir Gatzinsky ◽

Kate Abrahamsson ◽

Matilda Bräutigam ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Surgical Care ◽

Transition Model ◽

Inflammatory Bowel

Download Full-text

Applying Enhanced Recovery Pathways to Unique Patient Populations

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1676479 ◽

2019 ◽

Vol 32 (02) ◽

pp. 134-137 ◽

Cited By ~ 4

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.

Download Full-text

Inflammatory Bowel Disease in the United States from 1998 to 2005: Has Infliximab Affected Surgical Rates?

The American Surgeon ◽

10.1177/000313480907501025 ◽

2009 ◽

Vol 75 (10) ◽

pp. 976-980 ◽

Cited By ~ 10

Author(s):

Rebecca R. Cannom ◽

Andreas M. Kaiser ◽

Glenn T. Ault ◽

Robert W. Beart ◽

David A. Etzioni

Keyword(s):

United States ◽

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Surgical Care ◽

The United States ◽

Population Based ◽

Inflammatory Bowel

The treatment costs for patients in the United States with inflammatory bowel disease (IBD) exceed 1.7 billion dollars/year. Infliximab, an antibody to tumor necrosis factor-α, has been extensively used to treat IBD, with 390,000 IBD patients receiving the drug since its FDA approval in 1998. We sought to determine the impact of infliximab on population-based rates of hospitalizations and surgical care for patients with IBD in the United States. We used data from the Nationwide Inpatient Sample to analyze patterns of hospital-based treatment provided to patients with IBD between 1998 and 2005. Data from this analysis were combined with census data to calculate trends in population-based rates of treatment. Overall rates of hospitalization for patients with Crohn's disease and ulcerative colitis increased significantly between 1998 and 2005 (5.1%/year and 3.4%/year respectively, P < 0.001 for each). During the same time period there were no changes in the overall rates of surgical care. The expanding use of infliximab has not significantly impacted the use of surgical procedures for patients with either ulcerative colitis or Crohn's disease, and rates of nonsurgical hospitalizations have actually increased. Even in the era of infliximab, surgical care remains a mainstay in the treatment of IBD.

Download Full-text