Assessment and optimisation

Assessment and optimisation

Statement 5.5

Prior to elective surgery, a full assessment and optimisation of medical treatment and physical condition should be undertaken to minimise risk of complications and aid post-operative recovery.

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 ­– with referral to a dietitian or nutrition support team for appropriate nutritional support and/or supplementation
  • Reduction or stopping of medications including steroids and biological therapy 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. This needs to be managed effectively in accordance with guidelines, for example, with heparin. This is particularly important when coupled with the additional excess risk associated with surgical intervention

Once optimised, patients should undergo surgery within a tight timeframe to ensure best outcomes.