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.

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.

scholarly journals Risk factors for developing high-output ileostomy in CRC patients: a retrospective study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dongxiao Bai ◽  
Lei Li ◽  
Zhiling Shen ◽  
Tianchen Huang ◽  
Qingbing Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Anastomotic Leakage ◽  
Bowel Disease ◽  
Total Colectomy ◽  
Abdominal Infection ◽  
Inflammatory Bowel ◽  
High Output

Abstract Background Anastomotic leakage is one of the most serious postoperative complications of rectal cancer. Prophylactic ileostomy has been widely used to reduce the risk and severity of complications of anastomotic leakage. However, prophylactic ileostomy itself has some complications, and ileostomy high output syndrome (HOS) is one of them. This study was performed to explore the risk factors of HOS in ileostomy. Methods A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last 5 years. The relationship between HOS and the clinicopathological data was analyzed using the Chi-square test and Fisher’s exact probability. Multivariate analysis was performed by logistic regression. Results The incidence of HOS was 23.07% in this study. Dehydration was the most common symptom of HOS (37.7%). There was no clear correlation between HOS occurrence with sex, age, gross typing, histological grade, tumor location, lymph node metastasis, and TNM stage (p > 0.05). The incidence of HOS was 14/18 in inflammatory bowel disease patients, 18/28 in diabetes mellitus patients, and 23/72 in neoadjuvant chemoradiotherapy patients, 13/17 in total colectomy and abdominal infection patients. Multivariate analysis showed that they are risk factors for HOS (p < 0.05). Conclusion HOS occurred occasionally but rarely studied and lacks attention. Inflammatory bowel disease, diabetes mellitus, neoadjuvant radiotherapy chemotherapy, total colectomy and abdominal infection are the risk factors for HOS.

scholarly journals P154 Sinusitis Prompts Evaluation for Co-existing or Subsequent inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S214-S215
Author(s):  
V Rai ◽  
C Traboulsi ◽  
G Gulotta ◽  
D Rubin
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Bowel Disease ◽  
Categorical Variables ◽  
Continuous Variables ◽  
White Race ◽  
Black Race ◽  
Female Sex ◽  
Co Morbidity ◽  
Inflammatory Bowel

Abstract Background The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterised by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analyses from our group identified an increased prevalence of sinusitis among patients with IBD, predictive factors of developing sinusitis in IBD, and differences in stratifying patients with IBD and sinusitis (IBD+S) based on order in which these conditions were diagnosed. We now report on the factors associated with the development of IBD in patients with sinusitis. Methods This is a retrospective study at our tertiary IBD center. We utilised our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between 1/2000–5/2019 and age ≥18 years were included. Demographic and disease-related information were collected. Categorical variables were analysed using Fisher’s exact test and continuous variables were analysed using Wilcoxon rank-sum test. Results Of 14,366 patients with IBD, 386 (2.69%) patients have IBD+S. Of the 386 IBD+S patients, 118 patients (30.6%) were diagnosed with sinusitis before IBD. These 118 IBD+S patients were included in univariate and multivariate analysis with 14,753 non-IBD patients with sinusitis. The average age at IBD diagnosis among all IBD patients was 37.32 ± 18.79 years, and the average age at sinusitis diagnosis for sinusitis patients was 40.93 ± 21.42 years. On multivariate analysis, age of sinusitis diagnosis &gt;40 years old (OR 1.52, 95% CI 1.04–2.28), black race (OR 2.82, 95% CI 1.29–7.43), white race (OR 4.33, 95% CI 2.02–11.23), and female sex (OR 1.52, 95% CI 1.03–2.28) were significant predictors of IBD in sinusitis patients (Table 1A). In comparison, multivariate analysis showed that black race (OR 8.09, 95% CI 4.91–14.26), white race (OR 3.35, 95% CI 2.08–5.80), female sex (OR 1.51, 95% CI 1.22–1.87), and bowel obstruction (OR 2.00, 95% CI 1.53–2.58) were significantly associated with sinusitis in IBD patients (Table 1B). Conclusion Sinusitis patients diagnosed older than 40 years old have 1.5 greater odds of subsequent IBD, suggesting that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent IBD risk. Female sex and race are shared factors in the risk of sinusitis in IBD patients and risk of IBD in sinusitis patients.

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

Infection with cytomegalovirus in patients with inflammatory bowel disease: prevalence, clinical significance and outcome

2004 ◽  
Vol 53 (11) ◽  
pp. 1155-1160 ◽  
Author(s):  
Janak Kishore ◽  
Ujjala Ghoshal ◽  
Uday C Ghoshal ◽  
Narendra Krishnani ◽  
Sanjay Kumar ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Clinical Significance ◽  
Bowel Disease ◽  
Fisher Exact Test ◽  
Cmv Infection ◽  
Igm Antibody ◽  
Colonic Biopsy ◽  
Inflammatory Bowel ◽  
Histological Activity

Despite frequent use of immunosuppressive drugs in patients with inflammatory bowel disease (IBD) and reports of cytomegalovirus (CMV) infection following post-transplant immunosuppression, data on the frequency and clinical significance of CMV in patients with IBD are scant. Sixty-three patients with IBD (61 ulcerative colitis and two Crohn's disease) were evaluated for CMV using serology (IgM antibody, μ-capture ELISA), PCR for CMV DNA in colonic biopsy and histological assessment of haematoxylin and eosin-stained colonic biopsy. Positive result in any test was considered as CMV infection. Various parameters associated with CMV infection were analysed using univariate and multivariate analysis. Ten of 63 (15.8 %) patients (age 36.0 ± 11.2 years, 31 female) were infected with CMV (DNA alone in four, IgM antibody alone in two and both in four, inclusion body in one). Patients with CMV infection were more often female (8/10 vs 23/53, P < 0.05), had pancolitis (10/10 vs 33/53, P < 0.05), histological activity (9/10 vs 17/53, P < 0.005) and used azathioprine (5/10 vs 7/53, P = 0.04; Fisher exact test for all). On multivariate analysis, female gender, pancolitis and histological activity were the independent factors associated with infection. Patients with CMV infection more often required surgical treatment for IBD (4/10 vs 4/53, P = 0.01) and had fatal outcome (3/10 vs 0/53, P = 0.003). CMV infection in patients with IBD may be common and is associated with poor outcome. PCR of rectal biopsy was the most sensitive method of detection followed by IgM antibody for diagnosis.

scholarly journals P320 Thrombocytosis in acute inflammatory bowel disease: a useful biomarker?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S313-S314
Author(s):  
K Gazelakis ◽  
I Chu ◽  
C Martin ◽  
M Ward ◽  
M Sparrow
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Bowel Disease ◽  
Acute Diarrhoea ◽  
Inclusion Criteria ◽  
Infectious Gastroenteritis ◽  
Significant Difference ◽  
Inflammatory Bowel ◽  
And Biological Markers

Abstract Background Differentiating between infectious gastroenteritis and a flare of inflammatory bowel disease (IBD) can be difficult. Small studies have shown that thrombocytosis may not occur in infectious gastroenteritis. We aimed to determine whether thrombocytosis is a reliable biomarker in distinguishing between these two diagnoses in patients presenting with diarrhoea. Methods A retrospective cohort study was conducted at a tertiary referral IBD centre. From January 2000 and December 2018, patients admitted with acute diarrhoea were included. Inclusion criteria were infective gastroenteritis, IBD flare or both. IBD diagnosis was confirmed by standard clinical, radiological and histopathological criteria. Clinical and biochemical parameters were collected. Results There were 351 infectious and 506 IBD flare cases. Among these 216 (42.8%) had Crohn’s disease, 276 (54.7%) ulcerative colitis, and 13(2.6%) had IBD-unclassified. Table 1 summarises the main results. Those with acute IBD flare had a longer duration of diarrhoea, bloody diarrhoea, lower albumin and anaemia (p &lt; 0.05 for all comparisons). Patients with infectious diarrhoea were more likely to be older, female, have vomiting and fever and leucocytosis (p &lt; 0.05 for all comparisons). Median platelet count was higher in patients with IBD flares, 334 vs. 220 (p &lt; 0.001) and persisted on multivariate analysis (p &lt; 0.001, OR1.45). On multivariate analysis, other significant associations for IBD flare were age (OR.85, p &lt; 0.001) female sex (OR.23, p &lt; 0.110), blood in faeces (OR 5.98, p &lt; 0.001) vomiting (OR .17, p &lt; 0.001) and albumin (OR.83, p = 0.02). A sub-analysis compared patients with known IBD and infectious gastroenteritis with an identified pathogen (n = 47), with those with an IBD flare alone showed no significant difference in platelet count between groups (419 vs. 465, respectively, p = 0.17). Conclusion Our study shows significant differences between clinical and biological markers in patients with acute IBD flares compared with those with infectious gastroenteritis. In particular, thrombocytosis occurs in IBD flares but not in infectious gastroenteritis. This biomarker can be used to differentiate between these diagnoses and guide management.

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