Factors impeding the successful implementation of ERAS in patients undergoing colorectal resection for inflammatory bowel disease

Background&Aims Recent literatures indicated that patients with inflammatory bowel disease (IBD) could also benefit from enhanced recovery after surgery (ERAS) protocols. However, there are few studies investigating the failure of ERAS in patients undergoing colorectal resection specifically for IBD. The current study aimed to analyze the risk factors contributing to failure of ERAS after colorectal resection in IBD patients. Methods From January 2019 to February 2021, consecutive patients who underwent colorectal resection for IBD under ERAS protocol were retrospectively analyzed. ERAS failure was defined as prolonged postoperative length of hospital stay (LOS), i.e. 75th percentile of postoperative LOS for patients with IBD surgery, unplanned reoperation, accidental readmission or death within 30 postoperative days. Univariate and multivariate analysis were performed to identify risk factors for ERAS failure in IBD surgery. Results Overall, 216 patients were enrolled and 65(30.1%) were defined as ERAS failure. Multivariate analysis showed that preoperative NRS-2002 score ≥ 3 (OR = 2.844; 95% CI, 1.371–5.901; p = 0.005), modified Glasgow Prognostic Score (mGPS) = 2 (OR = 3.653; 95% CI, 1.455–9.173; p = 0.006), preoperative steroids use (OR = 2.313; 95%CI, 1.111–4.818; p = 0.025), and failure to mobilization on POD1 (OR = 3.105; 95%CI,1.528–6.308; p = 0.002) were independent risk factors for ERAS failure after IBD surgery. Conclusions Preoperative NRS-2002 score ≥ 3, mGPS = 2, preoperative steroids use, and failure to mobilization on POD1 are independent risk factors associated with ERAS failure in IBD patients after colorectal resection. Strategies aiming at these risk factors might promote the successful implementation of ERAS in IBD surgical patients.