Surgical management of inflammatory bowel disease (IBD) is a challenging task.
Preoperative optimization decreases the risk of complications and reduce the length of postoperative stay.
Dr Marie Strøm Zangenberg and colleagues from Denmark reviewed and graded the available evidence, attain clear recommendations, and point out potential future research.
The studies were identified from electronic databases and scanning reference lists in relevant papers.
English-written studies examining preoperative optimization in adult patients with IBD were included.
The team investigated 8 preoperative optimization factors.
|Oral antibiotics 24 hours prior to open surgery might improve outcome|
|International Journal of Colorectal Disease|
Management of IBD is a multidisciplinary task.
The researchers observed that steroid withdrawal is recommended while steroid stress dose is not recommended.
The team note that 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.
The research team found that 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 should be used.
The team observed that oral antibiotics 24 hours prior to open surgery might improve outcome if given as complementary to IV perioperative antibiotics.
Mechanical bowel preparation is not supported by evidence.
Comorbidities must be treated accordingly prior to surgical intervention.
The team report that smoking cessation can be beneficial for wound healing.
Dr Zangenberg's team concludes, "Multimodel preoperative optimization intervention in IBD patients is recommended."