Perioperative Enhanced Recovery Concepts Significantly Improve Postoperative Outcome in Patients with Crohn`s Disease.

Autor:	Kelm M; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Wagner L; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Widder A; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Pistorius R; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Wagner JC; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Schlegel N; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Markus C; University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medication, Würzburg, Germany., Meybohm P; University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medication, Würzburg, Germany., Germer CT; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany., Schwenk W; GOPOM GmbH, Gesellschaft für Optimiertes PeriOperatives Management, Duesseldorf, Germany., Flemming S; University Hospital Würzburg, Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg, Germany.
Jazyk:	angličtina
Zdroj:	Journal of Crohn's & colitis [J Crohns Colitis] 2024 Nov 04; Vol. 18 (11), pp. 1857-1862.
DOI:	10.1093/ecco-jcc/jjae090
Abstrakt:	Background and Aims: Despite recent advancements in medical and surgical techniques in patients suffering from Crohn`s disease [CD], postoperative morbidity remains relevant due to a long-standing, non-curable disease burden. As demonstrated for oncological patients, perioperative enhanced recovery concepts provide great potential to improve postoperative outcome. However, robust evidence about the effect of perioperative enhanced recovery concepts in the specific cohort of CD patients is lacking. Methods: In a prospective, single-centre study, all patients receiving ileocaecal resection due to CD between 2020 and 2023 were included. A specific, perioperative, enhanced recovery concept [ERC] was implemented and patients were divided into two groups [before and after implementation]. The primary outcome focused on postoperative complications as measured by the Comprehensive Complication Index [CCI], secondary endpoints were severe complications, length of hospital stay, and rates of re-admission. Results: Of 83 patients analysed, 33 patients participated in the enhanced recovery programme [post-ERC]. Whereas patient characteristics were comparable between both groups, ERC resulted in significantly decreased rates of overall and severe postoperative complications [CCI: 21.4 versus 8.4, p = 0.0036; Clavien Dindo > 2: 38% versus 3.1%, p = 0.0002]. Additionally, post-ERC-patients were ready earlier for discharge [5 days versus 6.5 days, p = 0.001] and rates of re-admission were significantly lower [3.1% versus 20%, p = 0.03]. In a multivariate analysis, the recovery concept was identified as independent factor to reduce severe postoperative complications [p = 0.019]. Conclusion: A specific, perioperative, enhanced recovery concept significantly improves the postoperative outcome of patients suffering from Crohn`s disease. (© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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