Int J Colorectal Dis. 2023 Oct 19;38(1):254. doi: 10.1007/s00384-023-04537-z.

Michiel Thomas Jan Bak ¹, Oddeke van Ruler ^2 3, Laurents Stassen ⁴, Marit Ruiterkamp ¹, Jeanine Hubertina Catharina Arkenbosch ¹, Gerard Dijkstra ⁵, Maria Johanna Elisabeth Campmans-Kuijpers ⁵, Nico Leonard Ulrich van Meeteren ^6 7, Bart Chateau Bongers ^8 9, Mariëlle Romberg-Camps ¹⁰, Sander van der Marel ¹¹, Frank Hoentjen ^12 13, Koen Willem van Dongen ¹⁴, Rachel West ¹⁵, Janneke van der Woude ¹, Annemarie Charlotte de Vries ¹⁶; Dutch Initiative Crohn and Colitis (ICC) and Dutch Initiative on Crohn and Colitis – Surgery (ICC-S)

Author information

¹Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, Rotterdam, GD, The Netherlands.

²Department of Surgery, IJsselland Hospital, Capelle Aan Den IJssel, The Netherlands.

³Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.

⁴Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

⁵Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.

⁶Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.

⁷Top Sector Life Sciences & Health (Health~Holland), The Hague, The Netherlands.

⁸Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.

⁹Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

¹⁰Department of Gastroenterology and Hepatology, Geriatrics and Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Center, Sittard-Geleen, The Netherlands.

¹¹Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, The Netherlands.

¹²Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands.

¹³Division of Gastroenterology, University of Alberta, Edmonton, Canada.

¹⁴Department of Surgery, Maasziekenhuis Pantein, Boxmeer, The Netherlands.

¹⁵Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands.

¹⁶Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, Rotterdam, GD, The Netherlands. a.c.devries@erasmusmc.nl.

Abstract

Purpose: Recently, recommendations on perioperative care have been published to optimize postoperative outcomes in preoperative patients with inflammatory bowel disease. This study evaluated the current use of preoperative screening and prehabilitation strategies (PS) prior to elective ileocolic resection (ICR) in patients with Crohn's disease (CD).

Methods: Patients with CD who underwent an elective ICR were identified from a Dutch prospective cohort study. Primary endpoint was to evaluate to what extent IBD-relevant PS were applied in patients with CD prior to ICR according to the current recommendations.

Results: In total, 109 CD patients were included. Screening of nutritional status was performed in 56% of the patients and revealed malnutrition in 46% of these patients. Of the malnourished patients, 46% was referred to a dietitian. Active smoking and alcohol consumption were reported in 20% and 28%; none of these patients were referred for a cessation program. A preoperative anemia was diagnosed in 61%, and ferritin levels were assessed in 26% of these patients. Iron therapy was started in 25% of the patients with an iron deficiency anemia. Exposure to corticosteroids at time of ICR was reported in 29% and weaned off in 3%. Consultation of a dietitian, psychologist, and physiotherapist was reported in 36%, 7%, and 3%. Physical fitness was assessed in none of the patients.

Conclusion: PS are not routinely applied and not individually tailored in the preoperative setting prior to elective ICR in patients with CD. Prior to implementation, future research on the costs and effectiveness of PS on postoperative outcomes and quality of life is necessary.