Enhanced Recovery Protocol Boosts Crohn’s Surgery Outcomes

TOPLINE:

A perioperative enhanced recovery protocol significantly improved the postoperative outcomes in patients undergoing ileocecal resection for Crohn’s disease, speeding discharge readiness and reducing complications and readmissions.

METHODOLOGY:

• Researchers conducted a prospective study to investigate the impact of a perioperative protocol involving enhanced recovery concepts on the outcomes of patients undergoing ileocecal resection for Crohn’s disease between 2020 and 2023 at a single center in Germany.
• The 83 participants were divided into pre- and post-protocol implementation groups (n = 50 and n = 33, respectively).
• The protocol included patient education, preoperative nutritional and health optimization, minimally invasive surgery if applicable, early postsurgical mobilization, multimodal analgesia, and early oral feeding.
• The primary outcome was postoperative morbidity after 30 days calculated using the Comprehensive Complication Index (CCI). Secondary endpoints were length of hospital stay, readmission rates, and severe complications, defined as above grade 2 on the Clavien-Dindo classification system for postsurgical complications.

TAKEAWAY:

• Implementation of the protocol led to a significant reduction in CCI from 21.4 to 8.4 (P = .0036).
• The protocol was an independent factor associated with fewer postoperative complications (odds ratio, 0.14; P = .0019).
• Patients in the post-protocol group had a lower rate of severe postsurgical complications (3.1% vs 38%; P = .0002), were ready for discharge earlier (5 vs 6.5 days; P = .001), and had a lower readmission rate (3.1% vs 20%; P = .03).
• Patients in the post-protocol group tended to have shorter hospital stays (5 vs 7 days), but the difference did not reach statistical significance (P = .06).

IN PRACTICE:

On the basis of our results, a specific perioperative recovery concept, including multiple disciplines, should be recommended for patients with inflammatory bowel disease, the authors noted.

SOURCE:

The study, led by Matthias Kelm, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wϋrzburg, Wϋrzburg, Germany, was published online in the Journal of Crohn’s and Colitis.

LIMITATIONS:

The study’s limitations include the lack of randomization and blinding, along with the relatively small number of patients, all of whom were referred from only a single tertiary center.

DISCLOSURES:

This study did not receive any funding. One author reported serving as the executive director of GOPOM GmbH. Other authors did not disclose any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.