P228 Prehabilitation strategies prior to ileocolonic resection in Crohn’s disease in a prospective cohort study: a missed window of opportunity?
Ruiterkamp, M.(1);Arkenbosch, J.(1);van Ruler, O.(2);van der Marel, S.(3);van Dongen, K.(4);Maljaars, P.W.J.(5);Hoentjen, F.(6);West, R.(7);Jharap, B.(8);Dijkstra, G.(9);Campmans-Kuijpers, M.(10);Jansen, S.(11);Romberg-Camps, M.(12);Stassen, L.(13);van der Woude, C.J.(1);de Vries, A.(1);
(1)Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands;(2)IJsselland Hospital, Surgery, Capelle a/d IJssel, The Netherlands;(3)Haaglanden Medical Center, Gastroenterology and Hepatology, The Hague, The Netherlands;(4)Pantein Hospital, Surgery, Boxmeer, The Netherlands;(5)Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, The Netherlands;(6)Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, The Netherlands;(7)Fransiscus Gasthuis & Vlietland, Gastroenterology and Hepatology, Rotterdam, The Netherlands;(8)Meander Medical Center, Gastroenterology and Hepatology, Amersfoort, The Netherlands;(9)University Medical Center Groningen and University of Groningen, Gastroenterology and Hepatology, Groningen, The Netherlands;(10)University Medical Center Groningen and University of Groningen, Gastroenterology and Hepatology, Groningen, The Netherlands;(11)Reinier de Graaf Groep, Gastroenterology and Hepatology, Delft, The Netherlands;(12)Zuyderland Medical Center, Gastroenterology and Hepatology, Sittard-Geleen, The Netherlands;(13)Maastricht University Medical Center, Surgery, Maastricht, The Netherlands
Background
Prehabilitation strategies to improve the postoperative course after intestinal resections in Crohn’s disease (CD) are mostly non-evidence-based. Prehabilitation strategies may include preoperative nutritional, physical and psychological management and optimization of medical treatment prior to surgery. In this study, we explore whether and to what extent prehabilitation strategies are currently used in a real-world prospective cohort.
Methods
In this multicenter prospective cohort study, data were collected in three secondary and two tertiary Dutch hospitals. CD patients (pts) aged ≥ 18 years who underwent ileocecal or ileocolonic (re)resection were included between November 2017 and January 2021. Data were collected on disease severity, IBD medication at time of surgery, preoperative BMI, weight loss within a year prior to resection, assessment of sarcopenia and hand grip strength (HGS), laboratory assessment, including albumin and micronutrients, and preoperative visits to a dietician, physiotherapist and psychologist. In addition, the 30-day postoperative complication rate was recorded.
Results
To date, 90 pts were included (38% male, median age 35.6 years) (Table 1). The main indications for ileocolonic resection were stenosis (55 (61%)), therapy refractory inflammation (15 (17%)) and penetrating disease (14 (18.9%)). At time of surgery, 60 pts (67%) were on IBD medication (immunomodulator n=16; biological n=22; combination therapy n=11, corticosteroids n=19). Median preoperative BMI was 23.7 kg/m2 (IQR 20.9-27.2). Sarcopenia and HGS were not assessed. Preoperative weight within a year prior to resection was recorded in only 31/90 (34%) pts. During the preoperative period, 32/90 pts (36%) visited a dietician, of whom 25/32 (78%) received a nutritional intervention (enteral support 16 (64%), parenteral support 0, exclusive enteral nutrition (EEN) 7 (28%), total parenteral nutrition (TPN) 2 (8%)). 4/90 pts (4%) visited a physiotherapist and 6/90 (7%) a psychologist. Albumin was assessed in 52/90 (58%) pts (median 38 (IQR 32-45); ferritin, vitamin B12 and D in 9/90 (10%), 10/90 (11%), 6/90 (7%) patients. Postoperative complication occurred in 32/90 (36%) pts, most often infections (68%) (Table 2). Four pts underwent a re-intervention for abdominal infection (2/4), anastomotic leakage (1/4) or ileus (1/4). Five pts (16%) were readmitted for anastomotic leakage (2/5), ileus (1/5), abdominal pain (1/5) and infection (1/5).
Conclusion
Prehabilitation strategies are not routinely applied in CD patients scheduled for ileocolonic resection and, since postoperative complications occur in more than a third of patients, further research into the yield of implementing multimodal prehabilitation is indicated.