Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, OH, USA.
Inflamm Bowel Dis. 2020 Feb 11;26(3):476-483. doi: 10.1093/ibd/izz172.
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.
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.
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.
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.
增强恢复途径（ERPs）已被证明可减少结直肠手术后的住院时间（LOS）、并发症和成本；然而，关于炎症性肠病（IBD）患者的数据很少。我们假设，为 IBD 患者实施 ERP 与 LOS 缩短和改善经济结果相关。
使用经机构审查委员会批准的前瞻性临床数据库，从 2015 年到 2017 年，确定连续患者。根据全面 ERP 实施的日期，将患者分为“ERP 前”和“ERP 后”两组。排除回肠造口关闭、重复造袋手术和门诊手术。使用单变量和多变量分析评估 ERP、LOS 和次要结果之间的关系。
总体上，共纳入 671 例患者：345 例（51.4%）克罗恩病（CD）和 326 例（48.6%）溃疡性结肠炎（UC）。其中，425 例为 ERP 前（63.4%），246 例为 ERP 后（36.6%）。两组在年龄、性别、美国麻醉医师协会（ASA）评分、合并症、估计失血量或造口术结构方面无差异。ERP 后组的平均体重指数（BMI）更高，CD 患者更多，手术时间更长，微创手术（MIS）更多（均 P < 0.05）。ERP 后组的 LOS 显著缩短（6 天比 4.5 天，中位数），而平均住院费用降低 15.7%。再入院率或并发症无差异。多变量分析显示，MIS 和 ERP 使用均与 LOS 缩短相关。
IBD 患者受益于 ERP 的使用，表现为 LOS 和成本降低，而并发症和再入院率没有增加。在这种具有挑战性的患者群体中，应常规实施增强恢复途径。
