Has the use of enhanced recovery protocols in IBD surgery increased postoperative bleeding complications?

BACKGROUND

Enhanced Recovery After Surgery (ERAS) protocols improve recovery after colorectal surgery but include NSAIDs and COX-2 inhibitors that may increase gastrointestinal bleeding risk. We evaluated the association between ERAS and postoperative bleeding in IBD patients undergoing colorectal resection.

METHODS

A prospectively maintained registry was reviewed for elective IBD-related colorectal resection with anastomosis before and after ERAS protocol implementation. Outcomes included postoperative bleeding, transfusion, intervention, length of stay, and 30-day readmission.

RESULTS

The cohort included 964 patients (466 ERAS, 498 non-ERAS). Bleeding without sequelae (14% vs 5%, p < 0.001) and bleeding with sequelae (5% vs 2%, p = 0.01) were more common in the ERAS group. Transfusion and intervention rates did not differ. On multivariable analysis, ERAS was independently associated with bleeding with sequelae (OR 2.6, 95% CI 1.2-5.7; p = 0.02).

CONCLUSIONS

ERAS use in IBD colorectal surgery was associated with increased postoperative bleeding. Most events were self-limited and did not require transfusion or intervention.