Decreased ER visits and Readmission After Implementation of a Standardized Perioperative Toolkit for Children with IBD
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In brief
In brief
Implementation of a multidisciplinary IBD clinic with ERAS protocols significantly reduced 30-day ER visits (27% to 9.3%) and readmissions (24.3% to 2.3%) in 41 pediatric patients undergoing abdominal surgery. The clinic integrated wound/ostomy care, nutrition, and social work resources to optimize perioperative management.
Written by the GCMD Library team from the article.
Background
Pediatric Inflammatory Bowel Disease (IBD) carries significant morbidity and requires extensive medical and often surgical intervention. The aim of this study was to evaluate the impact of a dedicated Multidisciplinary clinic on the outcomes of children with IBD.
Methods
A retrospective review of a prospective database, established to track quality and outcomes of children undergoing an abdominal operation for IBD, was performed. Children who were managed before (09/2017-03/2019) and after (04/2019-06/2020) establishment of the multidisciplinary clinic were examined. The clinic instituted several care process protocols including early recovery (ERAS) and garnered additional resources for patients (wound ostomy, nutrition, social work, etc.) Primary outcomes were unanticipated return to the operating room, length of stay, ER visits within 30 days of surgery and hospital readmissions within 30 days of surgery.
Results
We identified 41 children who underwent a total of 80 major abdominal operations; 46.3% of procedures occurred before and 53.7% occurred after instituting our clinic. There were no notable changes in disease distribution (e.g., ulcerative colitis vs. Crohn's), disease severity, medication exposure, or case urgency (elective vs. emergent). ER visits within 30 days of surgery decreased (4 (9.3%) vs. 10 (27%), p=0.04) as did readmissions within 30 days of surgery (1 (2.3%) vs. 9 (24.3%), p=0.005).
Conclusions
Implementation of a dedicated multidisciplinary clinic for IBD and its attendant focus on protocols and appropriate use of adjunctive resources was associated with decreased emergency department visits and hospital readmissions in the post-operative setting.