Why is it important?
There are many things to consider before someone has an operation to ensure they have the best possible recovery. To prepare people with IBD correctly for surgery, it takes complex decision-making and multidisciplinary input and planning.
Pre-operative assessment should include:
- A nutritional risk assessment completed for all patients– with referral to a dietitian or nutrition support team for appropriate nutritional support and/or supplementation as required, including pre-surgical exclusive enteral nutrition
- Reduction or stopping of medications including steroids where feasible
- Resolution of sepsis following radiological intervention and antibiotic therapy
- Drainage of any abscesses and associated treatment for people with fistulising Crohn’s
- Expert pathological assessment – this may involve referral of cases to a nationally recognised expert in the diagnosis and differential diagnosis of chronic IBD
- Risk of venous thromboembolism (VTE) – VTE is a well-recognised complication in patients with active IBD and this needs to be managed effectively in accordance with local guidelines and appropriate blood-thinning medications, timed appropriately around planned interventions. This is particularly important when coupled with the additional excess risk associated with surgical intervention
- Iron – consider preoperative IV iron for optimization if appropriate
Once optimised, patients should undergo surgery within a tight timeframe to ensure best outcomes.