Anne Meunier1, Giuseppe Sorce2, Pierre-Yves Hardy1, Carla Coimbra2, Emmanuel Decker2, Jean Joris3,4. 1. Department of Anaesthesiology and Reanimation, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, avenue de l'hôpital Bat B35, B-4000, Liège, Belgium. 2. Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, Liège, Belgium. 3. Department of Anaesthesiology and Reanimation, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, avenue de l'hôpital Bat B35, B-4000, Liège, Belgium. jean.joris@chuliege.be. 4. Groupe francophone de réhabilitation améliorée après chirurgie (GRACE; Francophone group for enhanced recovery after surgery, www.grace-asso.fr), Beaumont, France. jean.joris@chuliege.be.
Abstract
PURPOSE: Enhanced recovery programmes (ERPs) after surgery reduce postoperative complications and hospital stay. Patients with inflammatory bowel disease (IBD) often present risk factors for postoperative complications. This accounts for reluctance to include them in ERPs. We compared outcome after right colectomy with an ERP in IBD and non-IBD patients. METHODS: In our GRACE colorectal surgery database comprising 508 patients, we analysed patients scheduled for right colectomy (n = 160). Adherence to the protocol, postoperative complications and length of hospital stay of IBD patients (n = 45) were compared with those of non-IBD patients (n = 115). Data (mean ± SD, median [IQR], count (%)) were compared by Student's t, Mann-Whitney U and chi-square tests when appropriate; p < 0.05 taken as statistically significant. RESULTS: IBD patients were significantly younger (38.9 ± 13.8 vs. 58.9 ± 18.5 years, p < 0.001) and had lower BMI (23.0 ± 5.0 vs. 25.1 ± 5.0 kg m-2, p < 0.01). Adherence to ERP was similar in the two groups. Resumption of eating on the day of the operation was less well tolerated (73.3% vs. 85.2%, p < 0.05) and postoperative pain (p < 0.001) was greater in IBD patients. The incidence of postoperative complications (13.3% vs. 17.3%) and the length of hospital stay (3 [3-4.5] vs. 3 [2-5] days) were comparable in IBD and non-IBD patients, respectively. CONCLUSION: The management of IBD patients in an ERP is not only feasible but also indicated. These patients benefit as much from ERP as non-IBD patients.
PURPOSE: Enhanced recovery programmes (ERPs) after surgery reduce postoperative complications and hospital stay. Patients with inflammatory bowel disease (IBD) often present risk factors for postoperative complications. This accounts for reluctance to include them in ERPs. We compared outcome after right colectomy with an ERP in IBD and non-IBDpatients. METHODS: In our GRACE colorectal surgery database comprising 508 patients, we analysed patients scheduled for right colectomy (n = 160). Adherence to the protocol, postoperative complications and length of hospital stay of IBDpatients (n = 45) were compared with those of non-IBDpatients (n = 115). Data (mean ± SD, median [IQR], count (%)) were compared by Student's t, Mann-Whitney U and chi-square tests when appropriate; p < 0.05 taken as statistically significant. RESULTS:IBDpatients were significantly younger (38.9 ± 13.8 vs. 58.9 ± 18.5 years, p < 0.001) and had lower BMI (23.0 ± 5.0 vs. 25.1 ± 5.0 kg m-2, p < 0.01). Adherence to ERP was similar in the two groups. Resumption of eating on the day of the operation was less well tolerated (73.3% vs. 85.2%, p < 0.05) and postoperative pain (p < 0.001) was greater in IBDpatients. The incidence of postoperative complications (13.3% vs. 17.3%) and the length of hospital stay (3 [3-4.5] vs. 3 [2-5] days) were comparable in IBD and non-IBDpatients, respectively. CONCLUSION: The management of IBDpatients in an ERP is not only feasible but also indicated. These patients benefit as much from ERP as non-IBDpatients.
Entities:
Keywords:
Enhanced recovery programme; Inflammatory bowel disease; Postoperative outcome; Right colectomy; Surgery