EFFICACY OF ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS UNDERGOING ILEOCOLONIC RESECTIONS FOR CROHN'S DISEASE. A PROPENSITY SCORE ANALYSIS
Michela Mineccia2, Marco Daperno*1, Francesca Menonna2, Paola Germani2, Valentina Gentile2, Paolo Massucco2, Rodolfo Rocca1, Alessandro Ferrero2
1Gastroenterology Unit, Mauriziano Hospital, Torino, Equatorial Guinea; 2Surgery, Mauriziano Hospital, Turin, TO, Italy
Background
Enhanced Recovery After Surgery (ERAS) provides many benefits for patients with colorectal cancer. However, its application to patients with Crohn's disease (CD) is still questioned because of lack of evidence. The aim of this propensity matched study was to validate the results of ERAS protocol on CD patients.
Methods
This is a retrospective analysis of patients undergoing ileocolic resection for primary or recurrent CD from 2007 to 2017 at a single tertiary referral center in Italy. Patients enrolled in ERAS protocol were compared with those undergoing standard care, logistic regression identified factors for propensity matching ERAS patients. Therefore patients were propensity matched into two equal groups (ERAS vs non-ERAS). Patient demographic characteristics, length of stay, bowel function, oral intake, and perioperative morbidity were analyzed.
Results
A total of 285 patients underwent surgery for CD during the study period. From this group we considered 215 patients undergoing ileocolonic resections (23 ERAS vs 192 non-ERAS). After propensity match 46 out of 215 patients were considered for final analysis (23 ERAS and 23 matched non-ERAS patients). No significant difference was observed for age, gender, American Society of Anesthesiologists score, body mass index, previous surgery, operative time, laparoscopy. Median length of stay in ERAS and non-ERAS groups was 6 and 9 days (p=0.0036). Early bowel movement (within 3 days) in ERAS and non-ERAS groups was 14 (30.4%) and 3 (6.5%) respectively (p<0.001). Patients who tolerated early solid oral intake (within 3 days) in ERAS and non-ERAS groups were 14 (30.4%) and 1 (2.2%) respectively (p<0,001). No statistically differences in other postoperative outcomes were shown between the two groups.
Table 1 reports results on variables significantly and independently associated to lenght of hospital stay. Table 2 reports on results of multivaiate analysis in the propensity match population.
Conclusions
ERAS implementation was associated with a decreased length of stay, earlier bowel function and oral intake in patients who underwent laparoscopic or open ileocolic resection for primary or relapsing CD. Further and larger studies might be usefull to better clarify the role of ERAS in CD patients.
Table 1. Results of logistic regression to identify factors independently associated to hospital stay >6 days at multivariate analisys.
| Variable | p |
| Female gender | 0.038 |
| ASA≥2 | 0.01 |
| Surgical procedure duration | 0.0008 |
| Crude OR = 0.07 (95%CI 0.02 - 0.18) | |
p: p value; ASA: American Society of Anesthesiologists score; OR: odds ratio; 95%CI; 95% confidence interval
Table 2. Univariate analysis of operative and post-operative results of matched subgroups selected by propensity score analysis
| Variable | ERAS | Non-ERAS | Overall | p |
| Number of patients | 23 | 23 | 46 | NA |
| Median lengh of hospital stay, days (IQR) | 6 (5.5-8.5) | 9 (7.5-10) | 8 (6-9) | 0.004 |
| Number of patients with early free oral intake (≤3 days), (%) | 14 (61%) | 1 (4%) | 15 (33%) | <0.001 |
| Number of patients with early bowel movements (≤3 days), (%) | 14 (61%) | 3 (13%) | 17 (37%) | <0.001 |
All other comparisons of baseline characteristics or of operative /post-operative characteristics were non-significant. ERAS: enhanced recovery after surgery; p: p value; IQR: interquartile range; %: percentage.
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