P204 Preoperative optimization of patients with inflammatory bowel disease: a multicentre study of EIGA Group

Abstract

Background A significant percentage of patients with inflammatory bowel disease (IBD) will require surgical treatment at some point in their disease. Preoperative optimization (PO) intends to ensure that the patient arrives in optimal condition to surgery and to minimize the risk of complications. The aim of this study was to assess whether optimization criteria were met in patients with IBD undergoing elective surgery and to describe the percentage of post-surgical complications based on exposure to any of these risk factors. Methods IBD patients undergoing intra-abdominal surgery between 1st January 2013 and 30st September of 2021 were retrospectively selected. Data collection included clinical characteristic of IBD, nutritional biochemical parameters and surgical aspects. In addition, risk factors associated with a worse prognosis were collected. Among them, anemia, risk of malnutrition (using the Malnutrition Universal Screening Tool, MUST), smoking, presence of intra-abdominal sepsis and treatment received for IBD in the 30 days prior to surgery, especially the use of corticosteroids. Postsurgical complications were defined as those occurring within 30 days after surgery. Results A total of 212 surgeries performed in 5 centres from northwest of Spain were included: 87% in Crohn’s disease, 11% in ulcerative colitis and 2% in unclassified-IBD patients. Patients' clinical and demographic characteristics are summarized in Table 1. Postoperative complications were reported in 20.1% (n=62) of the patients, including suture dehiscence, infection, obstruction, bleeding and thrombosis. The most frequent complication was surgical site infection (10.8% of all the cases). Up to 35.6% of the patients were at risk of malnutrition at the time of surgery (MUST>=1), only half of these patients received some type of nutritional therapy. 20% of patients received at least 20 mg daily of prednisone or equivalent four weeks prior to surgery. Risk factors of post-surgical complications are presented in Table 2. Corticosteroid therapy (> 20 mg daily prednisone or equivalent) (OR 3.52 [95% CI: 1.05–12.6] (p=0.042) and the absence of nutritional support (OR 2.34 [95% CI:1.17-4.65] (p=0.016) were associated with postoperative complications. Multivariate and univariate analysis for postoperative complications are shown in Table 3 and Table 4. Conclusion The absence of a PO model increases the risk of postoperative complications. Inadequate preoperative nutritional care and corticosteroid therapy are risk factors for complications in our study. Protocols of PO in IBD patients are recommended.