Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support

Table 2

Preoperative assessment and management in CD patients [9].

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(i) Preoperative cross-sectional imaging

 (a) Identify sites of inflammation and assess for abscess, fistula, and stricture

(ii) Address modifiable risk factors

 (a) Smoking—stop preoperatively, even 4 weeks prior shows benefit

 (b) Steroids—wean preoperatively (ideally 4 weeks preoperatively)

 (c) Anemia—IV iron often needed, transfusion not usually indicated

(iii) Optimize nutritional status when indicated

 (a) Weight loss > 10–15% within 6 months

 (b) Body mass index < 18.5 kg/m²

 (c) Serum albumin < 3 g/dl (with no evidence of hepatic or renal dysfunction)

(iv) Preoperative colonoscopy (typically but not uniformly needed)

(v) Medical therapy through surgery

 (a) Thiopurines—no change

 (b) Anti-TNFs—assess levels and antibodies, try not to interrupt

 (c) Other biologics—little or no data

 (d) Thromboembolism prophylaxis—inpatient

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IV: intravenous; anti-TNF: tumor necrosis factor inhibitors.