ENHANCED RECOVERY PROGRAMS: HOW ARE WE BENEFITTING PATIENTS WITH IBD?

Abstract

Abstract BACKGROUND Enhanced Recovery Programs (ERPs) improve postoperative outcomes in colorectal surgery. Patients with IBD have been shown to benefit from use of ERP, but are immunosuppressed and chronically ill. We aimed to determine how patient outcomes under an ERP are affected by IBD. METHODS Patients undergoing colorectal surgery for IBD under an ERP from Oct 2015-May 2021 at a single institution were abstracted using ACS-NSQIP data, which was cross referenced with an internal health literacy database (BRIEF, 4-20). Adherence was defined as the sum of adherence to six components: pre-admission counseling, pre-op VTE prophylaxis, clear liquid diet pre-op, regional anesthesia, anti-emetic prophylaxis, and multi-modal pain management. Chi-square and two-sample t-test were used to compare patients with and without IBD. Multivariable linear and logistic regression were used to determine factors associated with IBD, SSI, and 30-day readmission. RESULTS Overall, patients (n=2,221) were 54% female, 76% White, 26% privately insured, 78% ASA Class 3, with mean age 57 yr, BMI 28.8 (SD=7.4). BRIEF scores were available for 644 patients, with a mean of 18.1. There were 308 patients (13.9%) undergoing surgery for IBD. Surgeries were 99.5% inpatient, 81.6% elective and 60% were laparoscopic. Procedure types included partial colectomy (69%), proctectomy (21%), total colectomy (6%), and total colectomy with proctectomy (4%). Overall ERP adherence was 59% (3.52 out of 6 components). Mean pLOS was 6.9 days (SD=7.7), SSI rate was 12.6%, readmission rate was 13.2% On univariate analysis, patients with IBD were younger (41 vs 60 yr, p<0.001), healthier at the time of surgery (ASA2: 23% vs 12%, ASA3: 73% vs 79%, p<0.001), and more male (53% vs 45%, p=0.02), White (82% vs 75%, p=0.004), and privately insured (42% vs 23%, p<0.001). IBD patients had lower BMI (27.4 vs 29, p<0.001) and more frequently underwent total colectomy (16% vs 5%) and total colectomy with proctectomy (14% vs 2%, p<0.001), as well as laparoscopic surgery (65% vs 59%, p=0.04). Despite similar ERP adherence (60% vs 59%, p=0.6), patients with IBD had higher rates of SSI (17% vs 12%, p=0.008) and readmission (20.6% vs 12%, p<0.001). On multivariable analysis, patients who were older (OR 0.92), Black (OR 0.25) or publicly insured (Medicaid OR 0.28, Medicare OR 0.53) we’re less like to have IBD. Those with IBD had greater health literacy scores (OR 1.11). Controlling for patient- and provider-level factors, patients with IBD were more likely to have post-operative SSI (OR 2.7) and readmission (OR 1.8). CONCLUSION Within an ERP, IBD is independently associated with greater rates of SSI and readmission despite factors associated with improved post-operative outcomes: younger age, private insurance, and greater health literacy. Additional research is needed to better adapt ERPs to the needs of patients with IBD.