Peri-Operative Outcomes of Patients with Inflammatory Bowel Disease After the Introduction of an ERAS Protocol – A Retrospective Cohort Review

Abstract

Purpose

Enhanced recovery after surgery (ERAS) programs are evidence-based protocols designed to standardize medical care, improve outcomes, and lower costs. Research shows that ERAS in colorectal surgery is associated with reduced length of stay (LOS) and morbidity, faster recovery and comparable or reduced readmission rates versus traditional models. Very little evidence exists assessing ERAS outcomes in inflammatory bowel disease (IBD) surgery. We hypothesized that ERAS protocols following IBD surgery is associated with a reasonable LOS and morbidity. Secondary aims were to identify factors affecting patient selection for ERAS programs in IBD surgery.

Patients and methods

A retrospective review of 119 patients undergoing abdominal surgery in a high volume IBD tertiary referral centre with a well-established ERAS protocol.

Results

During the study period, 119 patients with IBD underwent surgery. Of these, 78 patients were allocated to an ERAS protocol; compliance was 72%. The ERAS cohort were more likely to have laparoscopic surgery (53.8%), compared to the non-ERAS cohort (N-ERAS) (46.3%). Median hospital stay was significantly shorter in the ERAS cohort compared to the N-ERAS cohort (7 vs 9 days; p < 0.05). Operative time was significantly longer in the N-ERAS cohort (233 ± 73.0 vs 266 ± 96; p = 0.040). Complication rates were higher in the N-ERAS cohort (48.8% vs 37.1%; p = 0.33).

Conclusion

Patients undergoing surgery with an ERAS protocol have improved outcomes compared with patients deemed not suitable for ERAS. Factors affecting suitability are longer operations, a requirement for stoma, malnourished patients, patients with a higher ASA and the commencement of a new fellow to the unit.

Keywords:

• Crohn's disease
• ulcerative colitis
• enhanced recovery after surgery
• perioperative care

Author Contributions

All authors contributed equally as per the IMCJE authorship guidelines. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There has been no financial support for this work that could have influenced its outcome.