The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

Abstract

Background Enhanced recovery after surgery (ERAS) protocols are widely employed in colorectal surgery, successful in reducing postoperative morbidities and hospital length of stay (LOS). However, ERAS effects on the inflammatory bowel disease population remain unclear. This study examines the postoperative course of both Crohn’s disease (CD) and colon cancer (CC) patients after elective right hemicolectomies and compares the effectiveness of ERAS protocol. Methods A retrospective analysis was performed on patients with CD and CC undergoing elective right hemicolectomies and ileocecectomies from January 2014 through June 2016 (pre-ERAS) and January 2017 through April 2019 (post-ERAS) from a single tertiary care center. Patient demographics and perioperative variables were examined, including prolonged postoperative ileus (PPOI), hospital LOS, and 30-day readmission. Results 98 CC patients and 91 CD patients met the inclusion criteria. The pre-ERAS CC and post-ERAS CC cohorts were significantly different: post-ERAS had fewer patients with congestive heart failure and chronic obstructive pulmonary disease and had higher albumin levels. The pre-ERAS CC cohort had significantly longer operative durations and higher rates of concomitant procedures than the post-ERAS CC cohort. Both patients with CC and CD had a reduction in LOS with implementation of ERAS, decreasing by 2.24 days ( P = .002) and 1.21 days ( P = .038), respectively. There was a reduction in rates of organ space infections with CD (pre .132, post .00, P = .007). There was a trend towards an increased rate of PPOI with CD (Pre .079, Post .226, P = .062). Discussion The ERAS protocol significantly reduced LOS for both groups, without increasing 30-day readmission rates or other morbidities.

Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease

“…In our study, overall incidence of PPOI was 42.7%, which was higher than in previous studies that reported an incidence of 10 to 30% [5][6][7]23]. This difference could be explained since our cohort includes exclusively CD patients, who have a known higher risk for PPOI [24,25]. Furthermore, although the definitions of POI and PPOI were extensively discussed in various studies before, their inconsistent use in the literature contributes to incomparable results about the incidence and the risk factors of PPOI.…”

The implementation of an inflammatory bowel disease-specific enhanced recovery after surgery protocol: an observational cohort study

“…While other studies have shown similar reductions in LOS after the introduction of ERAS in surgery for IBD, none have reported an IBD-specific ERAS pathway [ 15 – 19 ]. Preoperative counseling with an IBD surgeon in the outpatient clinic, intravenous iron treatment for patients with iron-deficiency anemia, and preoperative risk stratification for anastomotic leakage were some of the items added to our department’s ERAS protocol utilized for patients undergoing surgery for colorectal cancer.…”