- Design
- Systematic review and meta-analysis (1 RCT, 17 observational studies)
- Population
- Adults with IBD undergoing colorectal surgery; 4,225 in length-of-stay analysis
- Primary outcome
- Length of stay, 30-day readmission, reoperation and complications
- Effect
- Length of stay −1.62 days (95% CI −2.03 to −1.21); readmission OR 0.83 (0.62–1.12)
This meta-analysis included 18 studies, one randomised and 17 observational, comparing enhanced recovery after surgery (ERAS) pathways with conventional care for colorectal surgery in adults with inflammatory bowel disease. IBD patients have often been excluded from ERAS research because of steroid use, malnutrition and complex disease.
Length of stay was 1.62 days shorter with ERAS (95% CI 1.21–2.03; moderate certainty). Readmissions (OR 0.83), reoperations (OR 0.68) and complications (OR 0.69) did not differ significantly, with low or very low certainty. Subgroup analyses hinted that IBD-specific pathways with more preoperative optimisation may help further.
The result supports applying ERAS to IBD surgery rather than treating these patients as exceptions. Most of the evidence is observational and unblinded, so selection bias is likely: patients put on ERAS may have been fitter.
- Include patients with IBD in enhanced recovery pathways for colorectal surgery.
- Optimise nutrition and taper steroids where possible before elective surgery.
- Plan perioperative steroid cover for patients on recent or current corticosteroids.
- Expect a shorter stay without a rise in readmissions.
Why it matters
It removes the main reason IBD patients have been left out of enhanced recovery.
Don't overread it
Most studies were observational; fitter patients may have been chosen for ERAS.
The statistics, in plain English
The odds ratios for complications (0.69) and reoperation (0.68) point towards benefit, but their intervals cross 1.0, so no difference was shown. GRADE 'low' and 'very low' certainty mean these estimates could easily change with better studies.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free