Do Patients With Inflammatory Bowel Disease Benefit from an Enhanced Recovery Pathway?

• Published in: Inflammatory bowel diseases Vol. 26; no. 3; pp. 476 - 483
• Main Authors: Liska, David, Bora Cengiz, Turgut, Novello, Matteo, Aiello, Alexandra, Stocchi, Luca, Hull, Tracy L, Steele, Scott R, Delaney, Conor P, Holubar, Stefan D
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 11-02-2020
• Subjects: Adult; Analysis; Critical Pathways; Databases, Factual; Economic aspects; Enhanced Recovery After Surgery; Enterprise resource planning; Evidence-based medicine; Female; Hospital Costs; Humans; Inflammatory Bowel Diseases - surgery; Length of Stay - statistics & numerical data; Linear Models; Male; Medical care, Cost of; Medical societies; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - rehabilitation; Multivariate Analysis; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Prospective Studies; Ulcerative colitis; United States; United States; enhanced recovery pathway; colorectal surgery; ulcerative colitis; inflammatory bowel disease; Crohn’s disease
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1093/ibd/izz172

Abstract
Background
Enhanced recovery pathways (ERPs) have been shown to reduce length of stay (LOS), complications, and costs after colorectal surgery; yet, little data exists regarding patients with inflammatory bowel disease (IBD). We hypothesized that implementation of ERP for IBD patients is associated with shorter LOS and improved economic outcomes.
Methods
An IRB-approved prospective clinical database was used to identify consecutive patients from 2015 to 2017. Patients were grouped as “pre-ERP” and “post-ERP” based on the date of implementation of a comprehensive ERP. Ileostomy closures, redo pouch operations, and outpatient operations were excluded. The relationship between ERP, LOS, and secondary outcomes was assessed using univariate and multivariate analysis.
Results
Overall, a total of 671 patients were included: 345 (51.4%) with Crohn’s disease (CD) and 326 (48.6%) with ulcerative colitis (UC). Of these, 425 were pre-ERP (63.4%), and 246 were post-ERP (36.6%). The groups did not differ in terms of age, gender, American Society of Anesthesiologist (ASA) scores, comorbidities, estimated blood loss, or ostomy construction. The post-ERP group had a significantly higher mean body mass index (BMI), more patients with CD, longer operative time, and more minimally invasive surgery (MIS; all P < 0.05). The post-ERP group had a significantly shorter LOS (6 vs 4.5 days, median), whereas mean hospital costs decreased by 15.7%. There was no difference in readmissions or complications. On multivariate analysis, MIS and ERP use were both associated with a shorter LOS.
Conclusion
Inflammatory bowel disease patients benefit from the use of ERP, demonstrating decreased LOS and costs without an increase in complications and readmissions. Enhanced recovery pathways should be routinely implemented in this often challenging patient population.
Enhanced recovery pathways (ERPs) improve outcomes following colorectal surgery. Little data exists regarding patients who undergo surgery for inflammatory bowel disease. In this paper we show that ERP implementation in this high risk group results in decreased length of stay and costs, without an increase in complications or readmissions.