title: Patient optimization for surgery relating to Crohn's disease.
abstract: The majority of patients with Crohn's disease require abdominal surgery during their lifetime, some of whom will require multiple operations. Postoperative complications are seen more frequently in patients requiring abdominal surgery for Crohn's disease than in patients requiring abdominal surgery for other conditions. In this article, we review the evidence supporting preoperative optimization, discussing strategies that potentially improve surgical outcomes and reduce perioperative morbidity and mortality. We discuss the roles of adequate cross-sectional imaging, nutritional optimization, appropriate adjustments of medical therapy, management of preoperative abscesses and phlegmons, smoking cessation and thromboembolic prophylaxis. We also review operation-related factors, and discuss their potential implications with respect to postoperative complications. Overall, the literature suggests that preoperative management has a major effect on postoperative outcomes.
authors: IBD Centre, Department of Gastroenterology, First Floor College House, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors: Kamal V
authors: KV
authors: Patel
authors: Department of Colorectal and General Surgery, First Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors: Amir A
authors: AA
authors: Darakhshan
authors: Department of Radiology, First Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors: Nyree
authors: N
authors: Griffin
authors: Department of Colorectal and General Surgery, First Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors: Andrew B
authors: AB
authors: Williams
authors: IBD Centre, Department of Gastroenterology, First Floor College House, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors: Jeremy D
authors: JD
authors: Sanderson
authors: IBD Centre, Department of Gastroenterology, First Floor College House, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors: Peter M
authors: PM
authors: Irving
mesh_terms: D018784:Abdominal Abscess / Q000601:surgery; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000714:Anastomosis, Surgical; D000740:Anemia / Q000209:etiology; D001685:Biological Factors / Q000627:therapeutic use; D002481:Cellulitis / Q000601:surgery; D019963:Clinical Chemistry Tests / Q000592:standards; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005080:Exercise Test; D006276:Health Facility Size; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D000072662:Margins of Excision; D009752:Nutritional Status; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism; D012907:Smoking / Q000009:adverse effects; D013923:Thromboembolism / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones; D001685:Biological Factors; D007166:Immunosuppressive Agents; D012709:Serum Albumin