Background The implementation of enhanced recovery after surgery (ERAS) protocols has decreased the length of stay (LOS) and complications in colorectal procedures. However, little data has been published on the subset of patients undergoing loop ileostomy closure. We investigated the outcomes of loop ileostomy reversals prior to and after initiation of an ERAS protocol. Methods Patients undergoing ileostomy reversal over a 5-year period by 4 colorectal surgeons were studied and divided into pre-ERAS patients and ERAS patients in a retrospective, case-control study. Patient demographics, comorbidities, LOS, underlying disease process, index intra-abdominal procedure, readmission rate, and complications were evaluated. Results Overall, 208 patients were analyzed 149 pre-ERAS and 59 ERAS–with median LOS significantly lower in the ERAS group than the pre-ERAS group (50.8 hours vs. 96.1 hours, P < .0001). In subgroup analysis, the LOS was significantly lower if the index procedure performed was laparoscopic when comparing ERAS to pre-ERAS (49.9 hours vs. 96.6 hours, P < .001). ERAS did not confer a significant decrease in the LOS during ileostomy reversal with open index procedures (72.9 hours vs. 95.5 hours, P = .05). Conclusion Utilizing an ERAS protocol is safe and effective for loop ileostomy closure with a shorter LOS and no difference in complication rates or 30-day readmission rates.
Diverticular disease is highly prevalent in the Western world, placing an increased burden on healthcare systems. This review clarifies the consensus in the literature on the disease’s classification, etiology, and management. Diverticular disease, caused by sac-like protrusions of colonic mucosa through the muscular colonic wall, has a varied disease course. Multiple theories contribute to our understanding of the etiology of the disease, with pathogenesis affected by age, diet, environmental conditions, lifestyle, the microbiome, genetics, and motility. The subtypes of diverticular disease in this review include symptomatic uncomplicated diverticular disease, segmental colitis associated with diverticulosis, and uncomplicated and complicated diverticulitis. We discuss emerging treatments and outline management options, such as supportive care, conservative management with or without antibiotics, and surgical intervention.
BACKGROUND: Inflammatory bowel disease patients are challenging to manage peri-operatively due to disease complexity and multiple comorbidities. OBJECTIVE: This study aimed to identify if preoperative factors and operation type were associated with extended postoperative length of stay after inflammatory bowel disease-related surgery, defined by 75 th percentile or greater (n = 926, 30.8%). DESIGN: This was a cross-sectional study based on a retrospective multicenter database. SETTING: The National Surgery Quality Improvement Program-Inflammatory Bowel Disease collaborative captured data from 15 high-volume sites. PATIENTS: A total of 3,008 patients with inflammatory bowel disease (1,710 with Crohn’s disease and 1,291 with ulcerative colitis) with a median postoperative length of stay of 4 days (IQR 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES: The primary outcome was extended postoperative length of stay. RESULTS: On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under ROC curve - 0.85). Clinically significant contributors that increased post-operative length of stay were rectal surgery (vs colon) (OR 2.13, 95% CI: 1.52-2.98), new ileostomy (vs no ileostomy) (OR 1. 50, 95% CI: 1.15-1.97), preoperative hospitalization (OR 13.45, 95% CI: 10.15-17.84), non-home discharge (OR 4.78, 95% CI: 2.27-10.08), hypoalbuminemia (OR 1.66, 95% CI: 1.27-2.18), and bleeding disorder (OR 2.42, 95% CI: 1.22-4.82). LIMITATIONS: Retrospective review of only high-volume centers. CONCLUSIONS: Patients with inflammatory bowel disease who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia and ASA classes 3-5. Chronic corticosteroid, immunologic, small molecule and biologic agent use were not significant on multivariable analysis.
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