FEASIBILITY OF A NURSE AND DIETITIAN-LED IBD SURGICAL PREHABILITATION PROGRAM

Surgery activates catabolic pathways that lead to loss of lean body mass and physical deconditioning, which can predispose to complications and delayed healing. Prehabilitation addresses modifiable risk factors, provides nutrition and functional status optimization, and has been shown to optimize surgical outcomes after cancer and/or orthopedic surgery. This includes decreased hospital length of stay (LOS), postoperative complications, readmission rates, and accelerated return to pre-surgical functional capacity. We assessed the feasibility of a structured, multidisciplinary prehabilitation program for patients with inflammatory bowel disease (IBD) undergoing abdominal surgery.

We developed a nurse-practitioner and dietitian-led IBD prehabilitation program for patients undergoing ileal-cecal resection (ICR) or colectomy. Perioperative nutrition and medications were addressed during two clinic visits (4 weeks before and after surgery). The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to define malnutrition. Sarcopenia was defined as either (1) two standard deviations below the norm for age and gender as assessed by dynamometry or (2) skeletal muscle index (SMI) <55 cm²/m² for males and <39 cm²/m² for females at the L3 region as assessed by computerized tomography. Micronutrients (iron profile, vitamin D, B6, zinc) were assessed and corrected if a deficiency was found. Patients were provided personalized diet recommendations for optimizing nutrition and were counseled on preoperative carbohydrate loading, and pre- and post-operative immunonutrition (IN). We assessed post-operative outcomes including post-operative length-of-stay (LOS), 30-day readmission, and perioperative complications of infection, abscess, and leak.

Ten patients (70% female, mean age 41 years) completed the program between 3/2021 and 5/2022. 9 underwent ICR and 1 underwent colectomy. 9 completed IN pre-operatively (90%); 9 (90%) completed carbohydrate loading pre-operatively, and 4 (40%) completed IN post-operatively. Upon initial assessment, 6 patients (60%) had malnutrition, and among the 4 patients with sarcopenia assessments, all 4 met criteria for sarcopenia. Forty percent had at least one micronutrient deficiency. Median post-operative LOS was 3.5 days. There were no readmissions within 30 days, and one patient had a postoperative infection.

A nurse practitioner- and dietician-led structured prehabilitation program is feasible. We hypothesize that low compliance with post-operative IN was due to formula not being available for inpatients at our facility; the impact of IN on post-operative outcomes should be evaluated in future studies. Further evaluation of outcomes associated with structured, multidisciplinary prehabilitation in IBD relative to usual care is warranted.