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Journal of Gastrointestinal Surgery

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01-01-2020 | Ileus | 2019 SSAT Quick Shot Presentation

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

Authors: Anthony P. D’Andrea, Prerna Khetan, Reba Miller, Patricia Sylla, Celia M. Divino

Published in: Journal of Gastrointestinal Surgery | Issue 1/2020

Abstract

Objective

To compare 30-day postoperative complications in patients with inflammatory bowel disease (IBD) undergoing colorectal resection before and after implementation of a hospital-wide surgical care bundle (SCB) to prevent surgical site infection (SSI) followed by enhanced recovery protocol (ERP).

Background

Perioperative SCBs to prevent SSI after colectomy have evolved to include ERPs demonstrating reduced rates of SSI, ileus, and length of stay in colorectal surgical patients. IBD patients often present with more risk factors for postoperative complication like malnutrition or immunosuppression, and the impact of SCBs and ERPs in this population is understudied.

Methods

Crohn’s disease and ulcerative colitis patients undergoing elective bowel resection at a tertiary-level referral center from 2013 to 2018 were retrospectively evaluated. Postoperative complications at 30 days including SSI, ileus, and anastomotic leak were compared between pre-SCB/ERP, post-SCB, and post-SCB + ERP time periods using institutional ACS-NSQIP data. Pediatric (age < 18 years) and emergent cases were excluded.

Results

Out of 977 patients, 224 were pre-SCB/ERP, 517 post-SCB, and 236 post-SCB + ERP. Gender (P = 0.01), race (P = 0.02), body mass index (P = 0.04), immunosuppressant use (P = 0.01), wound classification (P < 0.001), malnutrition (P < 0.001), duration of procedure (P = 0.04), and procedure performed (P = 0.01) were significantly different between the three cohorts. A significant decrease in the rates of SSI (14.7% to 5.5%), ileus (20.1% to 8.9%), and anastomotic leak (4.7% to 0.0%) was demonstrated after implementation of SCB and ERP (P ≤ 0.01). On multivariable regression, the risk for postoperative SSI and ileus decreased significantly post-SCB + ERP (OR 0.39, CI 0.19–0.82 and OR 0.45, CI 0.24–0.84, respectively).

Conclusion

SCB and ERP implementation was associated with decreased rates of postoperative SSI, ileus, and anastomotic leak for IBD patients undergoing elective bowel resection.

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Title: Outcomes After Bowel Resection for Inflammatory Bowel Disease in the Era of Surgical Care Bundles and Enhanced Recovery
Authors: Anthony P. D’Andrea
Prerna Khetan
Reba Miller
Patricia Sylla
Celia M. Divino
Publication date: 01-01-2020
Publisher: Springer US
Keywords: Ileus
Chronic Inflammatory Bowel Disease
Colectomy
Colectomy
Care
Published in: Journal of Gastrointestinal Surgery / Issue 1/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04362-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Objective

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Background

Methods

Results

Conclusion

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