A nurse practitioner- and dietician-led structured prehabilitation program positively impacted patients with inflammatory bowel diseases (IBD) after surgery, Andrea Banty, NP, DNP, highlighted during her poster presentation at the Crohn’s and Colitis Congress 2023, in Denver, Colorado.

Banty, NP, DNP, is a family nurse practitioner in the gastroenterology department at the Cedars-Sinai IBD Center in Los Angeles, California.

“Surgery activates catabolic pathways that lead to loss of lean body mass and physical deconditioning, which can predispose to complications and delayed healing,” said Banty who spearheaded the research with colleagues such as Kelly Issokson, MS, RD, CNSC, Phil Fleshner, MD, Gil Melmed, MD, Karen Zaghiyan, MD, FACS, FASCRS, Christina Ha, MD. “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.”

A well-balanced nutritional and medical program post-operation could lead to reduced number of days spent in hospital, postoperative complications, declined readmission rates, and quick return to patient’s functional capacity at pre-surgical level. The nurse-practitioner and dietitian-led IBD prehabilitation program used for the study was specifically designed for patients undergoing ileal-cecal resection (ICR) or colectomy.

The main concern throughout the study was malnutrition. During 2 clinic visits—4 weeks before surgery and 4 weeks after surgery—the researchers addressed perioperative nutrition and medications. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used as a gold standard to define malnutrition.

The study focused on the assessment and deficiency of micronutrients such as iron, vitamin D, B6, zinc; personalized diet recommendations for optimizing nutrition; and preoperative carbohydrate loading, and pre- and post-operative immunonutrition of 10 patients (70% female, mean age 41 years) who completed the program between 2021 and 2022.

Upon initial assessment, it was found that 6 patients (60%) had malnutrition. The remaining 4 patients met the sarcopenia assessments. The median post-operative length of stay in hospital was 3.5 days, 40% of the patients had at least one micronutrient deficiency, 1 patient had a postoperative infection, and there were no readmissions within 30 days.

A nurse practitioner- and dietician-led structured prehabilitation program is certainly feasible, Banty reiterated. “Further evaluation of outcomes associated with structured, multidisciplinary prehabilitation in IBD relative to usual care is warranted,” she said.

—Priyam Vora

Reference:
Banty A, Issokson K, Fleshner P, Melmed G, Zaghiyan K and Ha C. Presentation number: P083. Feasibility of a nurse and dietitian-led IBD surgical prehabilitation program. Presented at: Crohn’s and Colitis Congress 2023; January 19, 2023. Denver, Colorado.