Impact of Preoperative Factors in Patients with Inflammatory Bowel Disease on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

Inflammatory bowel disease patients are challenging to manage peri-operatively due to disease complexity and multiple comorbidities.This study aimed to identify if preoperative factors and operation type were associated with extended postoperative length of stay after inflammatory bowel disease-related surgery, defined by 75 th percentile or greater (n = 926, 30.8%).This was a cross-sectional study based on a retrospective multicenter database.The National Surgery Quality Improvement Program-Inflammatory Bowel Disease collaborative captured data from 15 high-volume sites.A total of 3,008 patients with inflammatory bowel disease (1,710 with Crohn's disease and 1,291 with ulcerative colitis) with a median postoperative length of stay of 4 days (IQR 3-7) from March 2017 to February 2020.The primary outcome was extended postoperative length of stay.On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under ROC curve - 0.85). Clinically significant contributors that increased post-operative length of stay were rectal surgery (vs colon) (OR 2.13, 95% CI: 1.52-2.98), new ileostomy (vs no ileostomy) (OR 1. 50, 95% CI: 1.15-1.97), preoperative hospitalization (OR 13.45, 95% CI: 10.15-17.84), non-home discharge (OR 4.78, 95% CI: 2.27-10.08), hypoalbuminemia (OR 1.66, 95% CI: 1.27-2.18), and bleeding disorder (OR 2.42, 95% CI: 1.22-4.82).Retrospective review of only high-volume centers.Patients with inflammatory bowel disease who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia and ASA classes 3-5. Chronic corticosteroid, immunologic, small molecule and biologic agent use were not significant on multivariable analysis.