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Preoperative optimization of patients with inflammatory bowel disease undergoing gastrointestinal surgery: a systematic review

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Surgical management of inflammatory bowel disease (IBD) is a challenging task. The aim of preoperative optimization (PO) is to decrease the risk of complications and reduce the length of postoperative stay. The aim of this study was to review and grade the available evidence, attain clear recommendations, and point out potential future research.

Methods

Studies were identified from electronic databases (PubMed, Embase, and Cochrane Library) and scanning reference lists in relevant papers. English-written studies examining PO in adult patients with IBD were included. Eight PO factors were investigated.

Results

Management of IBD is a multidisciplinary task. Steroid withdrawal is recommended while steroid stress dose is not recommended. Thiopurines appear to be safe, but it may be prudent to plan the procedure remotely from the last dose of an anti-TNF agent. Nutritional risk screening is recommended to unveil and correct any malnutrition. Thrombosis prophylaxis prior to surgery is well supported by evidence while extended 4-week prophylaxis needs further research. Percutaneous ultrasound or CT-guided drainage for intra-abdominal abscesses is recommended, but it is unclear for how long supplementary antibiotics (ABs) should be used. Oral AB 24 h prior to open surgery might improve outcome if given as complementary to IV perioperative AB. Mechanical bowel preparation is not supported by evidence. Comorbidities must be treated accordingly prior to surgical intervention. Smoking cessation can be beneficial for wound healing.

Conclusion

Multimodel PO intervention in IBD patients is recommended.

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Authors and Affiliations

  1. Department of Surgery, Zealand University Hospital, Køge, Denmark

    Marie Strøm Zangenberg

  2. Department of Surgery, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nir Horesh

  3. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Uri Kopylov

  4. Department of Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Alaa El-Hussuna

Authors
  1. Marie Strøm Zangenberg
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  2. Nir Horesh
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  3. Uri Kopylov
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  4. Alaa El-Hussuna
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Corresponding author

Correspondence to Alaa El-Hussuna.

Appendix. Search strategy from PubMed

Appendix. Search strategy from PubMed

((((((((((((nutritional support) OR ((enteral nutrition) OR parenteral nutrition))) OR ((((((((((((((((((((optimal preparation) OR optimisation) OR optimise) OR optimize) OR optimization) OR optimal preparation) OR preparation)) OR thrombosis prophylaxis) OR ((nutritional support) OR nutritional support[MeSH Major Topic])) OR nutritional support[MeSH Major Topic]) OR preoperative sepsis treatment) OR bowel rest) OR anticoagulants) OR nutritional support) OR period, preoperative) OR care, preoperative) OR ((sepsis therapy) OR sepsis treatment)) OR sepsis treatment) OR sepsis therapy))) AND ((surgery) OR colorectal surgery)) AND (Inflammatory bowel disease OR ibd OR Crohn disease OR crohn’s disease OR Colitis ulcerative)))) OR (((((“inflammatory bowel diseases”[MeSH Terms] OR (“inflammatory”[All Fields] AND “bowel”[All Fields] AND “diseases”[All Fields]) OR “inflammatory bowel diseases”[All Fields] OR (“inflammatory”[All Fields] AND “bowel”[All Fields] AND “disease”[All Fields]) OR “inflammatory bowel disease”[All Fields]) OR ibd[All Fields] OR (“crohn disease”[MeSH Terms] OR (“crohn”[All Fields] AND “disease”[All Fields]) OR “crohn disease”[All Fields]) OR (“crohn disease”[MeSH Terms] OR (“crohn”[All Fields] AND “disease”[All Fields]) OR “crohn disease”[All Fields] OR (“crohn’s”[All Fields] AND “disease”[All Fields]) OR “crohn’s disease”[All Fields]) OR (“colitis, ulcerative”[MeSH Terms] OR (“colitis”[All Fields] AND “ulcerative”[All Fields]) OR “ulcerative colitis”[All Fields] OR (“colitis”[All Fields] AND “ulcerative”[All Fields]) OR “colitis ulcerative”[All Fields]))) AND ((((“surgery”[Subheading] OR “surgery”[All Fields] OR “surgical procedures, operative”[MeSH Terms] OR (“surgical”[All Fields] AND “procedures”[All Fields] AND “operative”[All Fields]) OR “operative surgical procedures”[All Fields] OR “surgery”[All Fields] OR “general surgery”[MeSH Terms] OR (“general”[All Fields] AND “surgery”[All Fields]) OR “general surgery”[All Fields]) OR (“colorectal surgery”[MeSH Terms] OR (“colorectal”[All Fields] AND “surgery”[All Fields]) OR “colorectal surgery”[All Fields])) OR (“postoperative complications”[MeSH Terms] OR (“postoperative”[All Fields] AND “complications”[All Fields]) OR “postoperative complications”[All Fields])) OR ((“postoperative period”[MeSH Terms] OR (“postoperative”[All Fields] AND “period”[All Fields]) OR “postoperative period”[All Fields] OR “postoperative”[All Fields]) AND (“infection”[MeSH Terms] OR “infection”[All Fields] OR “infections”[All Fields])))) AND ((((((((“biological products”[MeSH Terms] OR (“biological”[All Fields] AND “products”[All Fields]) OR “biological products”[All Fields] OR “biologics”[All Fields]) OR “biological agent”[All Fields]) OR “biological agents”[All Fields]) OR (“biosimilar pharmaceuticals”[MeSH Terms] OR (“biosimilar”[All Fields] AND “pharmaceuticals”[All Fields]) OR “biosimilar pharmaceuticals”[All Fields])) OR (((“infliximab”[MeSH Terms] OR “infliximab”[All Fields] OR “remicade”[All Fields]) OR (“adalimumab”[MeSH Terms] OR “adalimumab”[All Fields] OR “humira”[All Fields])) OR (((((((“antibodies, monoclonal”[MeSH Terms] OR (“antibodies”[All Fields] AND “monoclonal”[All Fields]) OR “monoclonal antibodies”[All Fields] OR (“antibodies”[All Fields] AND “monoclonal”[All Fields]) OR “antibodies, monoclonal”[All Fields]) OR (“PEG-modified tumor necrosis factor-alpha”[Supplementary Concept] OR “PEG-modified tumor necrosis factor- alpha”[All Fields] OR "peg modified tumor necrosis factor alpha"[All Fields])) OR “tumor necrosis factor-alpha/antagonists and inhibitors”[Mesh Terms]) OR (anti[All Fields] AND tnf[All Fields])) OR anti-tnf[All Fields]) OR (“adalimumab”[MeSH Terms] OR “adalimumab”[All Fields])) OR (“infliximab”[MeSH Terms] OR “infliximab”[All Fields])))) OR ((((“steroids”[MeSH Terms] OR “steroids”[All Fields]) OR ((“Stress”[Journal] OR “stress”[All Fields]) AND dose[All Fields])) OR (“glucocorticoids”[Pharmacological Action] OR “glucocorticoids”[MeSH Terms] OR “glucocorticoids”[All Fields])) AND scheme[All Fields])) OR ((“comorbidity”[MeSH Terms] OR “comorbidity”[All Fields]) OR (“comorbidity”[MeSH Terms] OR “comorbidity”[All Fields] OR “comorbidities”[All Fields]))) OR (((“interdisciplinary studies”[MeSH Terms] OR (“interdisciplinary”[All Fields] AND “studies”[All Fields]) OR “interdisciplinary studies”[All Fields] OR “multidisciplinary”[All Fields]) OR ((“interdisciplinary studies”[MeSH Terms] OR (“interdisciplinary”[All Fields] AND “studies”[All Fields]) OR “interdisciplinary studies”[All Fields] OR “multidisciplinary”[All Fields]) AND teamwork[All Fields])) OR ((“interdisciplinary studies”[MeSH Terms] OR (“interdisciplinary”[All Fields] AND “studies”[All Fields]) OR “interdisciplinary studies”[All Fields] OR “multidisciplinary”[All Fields]) AND team[All Fields]))))) OR (((((((“Antibiotic Prophylaxis”[Mesh]) OR “Anti-Bacterial Agents”[Mesh])) OR (antibiotics OR “preoperative antibiotics” OR “anti bacterial prophylaxis”))) AND (((((“preoperative period” OR optimization OR preparation OR “optimal preparation” OR presurgery)) AND (“inflammatory bowel disease” OR IBD OR crohn’s))) OR ((((“Preoperative Period”[Mesh]) OR “Preoperative Care”[Mesh])) AND “Inflammatory Bowel Diseases”[Mesh]))))) OR ((((((((“psychological prehabilitation” OR “psychological interventon” OR “preoperative psychology”)) OR (“mental support” OR “mental health” OR psycotherapy OR “psychological support”))) AND (((((“preoperative period” OR optimization OR preparation OR “optimal preparation” OR presurgery)) AND (“inflammatory bowel disease” OR IBD OR crohn’s))) OR ((((“Preoperative Period”[Mesh]) OR “Preoperative Care”[Mesh])) AND “Inflammatory Bowel Diseases”[Mesh])))) OR (((((((“preoperative period” OR optimization OR preparation OR “optimal preparation” OR presurgery)) AND (“inflammatory bowel disease” OR IBD OR crohn’s))) OR ((((“Preoperative Period”[Mesh]) OR “Preoperative Care”[Mesh])) AND “Inflammatory Bowel Diseases”[Mesh]))) AND (“Smoking Cessation”[Mesh] OR smoking OR cigarette))))) OR ((((((((“preoperative period” OR optimization OR preparation OR “optimal preparation” OR presurgery)) AND (“inflammatory bowel disease” OR IBD OR crohn’s))) OR ((((“Preoperative Period”[Mesh]) OR “Preoperative Care”[Mesh])) AND “Inflammatory Bowel Diseases”[Mesh]))) AND (“bowel preparation” OR “mechanical bowel preparation” OR “colonic preparation” OR “colonic clensing”))) Filters: Publication date from 2005/01/01 to 2015/07/31; Humans.

Results ➔ 2349 items.

Similar searches were conducted in EMbase and Cochrane Library. Exact search strategies for those databases can be requested if necessary.

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Zangenberg, M.S., Horesh, N., Kopylov, U. et al. Preoperative optimization of patients with inflammatory bowel disease undergoing gastrointestinal surgery: a systematic review. Int J Colorectal Dis 32, 1663–1676 (2017). https://doi.org/10.1007/s00384-017-2915-4

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