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Lin V, Poulsen JK, Juvik AF, Roikjær O, Gögenur I, Fransgaard T. The implementation of an inflammatory bowel disease-specific enhanced recovery after surgery protocol: an observational cohort study. Tech Coloproctol 2024; 28:58. [PMID: 38796600 PMCID: PMC11127850 DOI: 10.1007/s10151-024-02933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/14/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The implementation of Enhanced Recovery After Surgery (ERAS) protocols has resulted in improved postoperative outcomes in colorectal cancer surgery. The evidence regarding feasibility and impact on outcomes in surgery for inflammatory bowel disease (IBD) is limited. METHODS We performed a retrospective observational cohort study, comparing patient trajectories before and after implementing an IBD-specific ERAS protocol at Zealand University Hospital. We assessed the occurrence of serious postoperative complications of Clavien-Dindo grade 3 or higher as our primary outcome, with postoperative length of stay in days and rate of readmissions as secondary outcomes, using χ2, Mann-Whitney test, and odds ratios adjusted for sex and age. RESULTS From 2017 to 2023, 394 patients were operated on for IBD and included in our study. In the ERAS cohort, 39/250 patients experienced a postoperative complication of Clavien-Dindo grade 3 or higher compared to 27/144 patients in the non-ERAS cohort (15.6% vs. 18.8%, p = 0.420) with an adjusted odds ratio of 0.73 (95% CI 0.42-1.28). There was a significantly shorter postoperative length of stay (median 4 vs. 6 days, p < 0.001) in the ERAS cohort compared to the non-ERAS cohort. Readmission rates remained similar (22.4% vs. 16.0%, p = 0.125). CONCLUSIONS ERAS in IBD surgery was associated with faster patient recovery, but without an impact on the occurrence of serious postoperative complications and rate of readmissions.
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Affiliation(s)
- V Lin
- Center for Surgical Science, Zealand University Hospital Koge, Lykkebækvej 1, 4600, Køge, Denmark.
| | - J K Poulsen
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark
| | - A F Juvik
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark
| | - O Roikjær
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark
| | - I Gögenur
- Center for Surgical Science, Zealand University Hospital Koge, Lykkebækvej 1, 4600, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T Fransgaard
- Center for Surgical Science, Zealand University Hospital Koge, Lykkebækvej 1, 4600, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pozios I, Seeliger H, Lauscher JC, Stroux A, Weixler B, Kamphues C, Beyer K, Kreis ME, Lehmann KS, Seifarth C. Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn's disease. Int J Colorectal Dis 2021; 36:2165-2175. [PMID: 34142229 PMCID: PMC8426236 DOI: 10.1007/s00384-021-03969-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Prolonged postoperative ileus (PPOI) is common after bowel resections, especially in Crohn's disease (CD). The pathophysiology of PPOI is not fully understood. PPOI could affect only the upper or lower gastrointestinal (GI) tract. The aim of this study was to assess risk factors for diverse types of PPOI, particularly to differentiate PPOI of upper and lower GI tract. METHODS A retrospective analysis of 163 patients with CD undergoing ileocecal resection from 2015 to 2020 in a single center was performed. PPOI of the upper GI tract was predefined as the presence of vomiting or use of nasogastric tube longer than the third postoperative day. Lower PPOI was predefined as the absence of defecation for more than three days. Independent risk factors were identified by multivariable logistic regression analysis. RESULTS Overall incidence of PPOI was 42.7%. PPOI of the upper GI tract was observed in 30.7% and lower PPOI in 20.9% of patients. Independent risk factors for upper PPOI included older age, surgery by a resident surgeon, hand-sewn anastomosis, prolonged opioid analgesia, and reoperation, while for lower PPOI included BMI ≤ 25 kg/m2, preoperative anemia, and absence of ileostomy. CONCLUSION This study identified different risk factors for upper and lower PPOI after ileocecal resection in patients with CD. A differentiated upper/lower type approach should be considered in future research and clinical practice. High-risk patients for each type of PPOI should be closely monitored, and modifiable risk factors, such as preoperative anemia and opioids, should be avoided if possible.
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Affiliation(s)
- Ioannis Pozios
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Hendrik Seeliger
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Johannes C. Lauscher
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Andrea Stroux
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Martin E. Kreis
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kai S. Lehmann
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
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