- Design
- Systematic review and meta-analysis of 18 studies (1 randomised, 17 observational); GRADE-assessed
- Population
- Adults with inflammatory bowel disease undergoing surgery (up to 4,225 patients per outcome)
- Primary outcome
- Length of stay, 30-day readmission, reoperation and complications
- Effect
- Length of stay −1.62 days (−2.03 to −1.21); no difference in readmission, reoperation or complications
Enhanced recovery after surgery (ERAS) is standard in colorectal cancer surgery, but patients with inflammatory bowel disease were largely left out of the trials. This meta-analysis of 18 studies — one randomised, the rest observational — compared ERAS with conventional care in adults with IBD undergoing surgery.
Length of stay fell by about 1.6 days with ERAS, at moderate certainty, while 30-day readmissions, reoperations and complications were no different. In other words the pathway moves patients home sooner without a safety penalty in a population that is often younger, malnourished or on immunosuppression.
The practical message is to apply ERAS components deliberately in IBD surgery rather than assuming the colorectal-cancer evidence does not transfer. The authors raise, but cannot yet confirm, that procedure-specific pathways with more preoperative optimisation might add further benefit.
- Length of stay was about 1.6 days shorter with ERAS (mean difference −1.62 days, 95% CI −2.03 to −1.21; 4,225 patients; moderate certainty).
- No difference in 30-day readmissions (odds ratio 0.83, 0.62–1.12), reoperations (0.68, 0.46–1.02) or complications (0.69, 0.45–1.08).
- Apply ERAS components — early feeding, multimodal analgesia, early mobilisation — deliberately in IBD surgery, not only in cancer resections.
- Most of the evidence is observational, so the length-of-stay gain is firmer than the neutral complication signal.
Why it matters
It removes the excuse that ERAS evidence was built only in cancer patients and does not apply to IBD surgery.
Don't overread it
Seventeen of 18 studies were observational and unblinded — the length-of-stay benefit is clearer than the neutral effect on complications.
The statistics, in plain English
A mean difference of −1.62 days with a confidence interval that stays below zero means the shorter stay is a real, consistent effect. The complication odds ratios all straddle 1.0, so there is no signal of harm — but with mostly observational data, absence of a signal is weaker than proof of safety.
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