TY - JOUR
T1 - Prehabilitation prior to intestinal resection in Crohn's disease patients: An opinion review
AU - Bak, M.T.J.
AU - Ruiterkamp, M.F.E.
AU - van Ruler, O.
AU - Campmans-Kuijpers, M.J.E.
AU - Bongers, B.C.
AU - van Meeteren, N.L.U.
AU - van der Woude, C.J.
AU - Stassen, L.P.S.
AU - de Vries, A.C.
N1 - Funding Information:
The authors would like to acknowledge the contribution of Wichor Bramer, biomedical information specialist of the Erasmus University Medical Center, for performing the systematic literature search.
Publisher Copyright:
©The Author(s) 2022.
PY - 2022/6/14
Y1 - 2022/6/14
N2 - Patients with Crohn's disease (CD) are at a considerable risk for intestinal surgery. Approximately 25% of patients with CD will undergo an intestinal resection within 10 years of diagnosis. Postoperative complications after CD surgery have been reported in 20%-47% of the patients. Both general and CD-related risk factors are associated with postoperative complications, and comprise non-modifiable (e.g., age) and potentially modifiable risk factors (e.g., malnutrition). Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient. The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity. Preoperative improvement of nutritional status, physical fitness, cessation of smoking, psychological support, and critical revision of preoperative use of CD medication are important strategies. Studies of the effect on postoperative outcome in CD patients are scarce, and guidelines lack recommendations on tailored management. In this opinion review, we review the current evidence on the impact of screening and management of nutritional status, physical fitness, CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients. In addition, we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.
AB - Patients with Crohn's disease (CD) are at a considerable risk for intestinal surgery. Approximately 25% of patients with CD will undergo an intestinal resection within 10 years of diagnosis. Postoperative complications after CD surgery have been reported in 20%-47% of the patients. Both general and CD-related risk factors are associated with postoperative complications, and comprise non-modifiable (e.g., age) and potentially modifiable risk factors (e.g., malnutrition). Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient. The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity. Preoperative improvement of nutritional status, physical fitness, cessation of smoking, psychological support, and critical revision of preoperative use of CD medication are important strategies. Studies of the effect on postoperative outcome in CD patients are scarce, and guidelines lack recommendations on tailored management. In this opinion review, we review the current evidence on the impact of screening and management of nutritional status, physical fitness, CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients. In addition, we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.
KW - Crohn's disease
KW - Prehabilitation strategies
KW - Nutrition
KW - Physical fitness
KW - Medication
KW - Laboratory values
KW - INFLAMMATORY-BOWEL-DISEASE
KW - INTRAABDOMINAL SEPTIC COMPLICATIONS
KW - EXCLUSIVE ENTERAL NUTRITION
KW - SURGICAL SITE INFECTIONS
KW - VEDOLIZUMAB-TREATED PATIENTS
KW - POSTOPERATIVE COMPLICATIONS
KW - RISK-FACTORS
KW - ILEOCOLONIC RESECTION
KW - PREOPERATIVE HYPOALBUMINEMIA
KW - ABDOMINAL OPERATIONS
U2 - 10.3748/wjg.v28.i22.2403
DO - 10.3748/wjg.v28.i22.2403
M3 - (Systematic) Review article
C2 - 35979261
SN - 1007-9327
VL - 28
SP - 2403
EP - 2416
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
IS - 22
ER -