Jean Ashburn, MD, on Perioperative Complications in IBD

Dr Jean Ashburn discusses the complications that can occur around the time of surgery among patients with inflammatory bowel disease.

Jean Ashburn, MD, is a board-certified colorectal surgeon and assistant professor in the Department of General Surgery at Atrium Health-Wake Forest Baptist Hospital in Winston-Salem, North Carolina.

My name is Jeanie Ashburn. I'm a colorectal surgeon at Atrium Health Wake Forest Baptist Hospital in Winston-Salem, North Carolina. I'm here at AIBD Regionals and I just spoke about postoperative complications in IBD.

As a surgeon, we think about this a lot—how important it is not only to manage the complications after surgery in our IBD patients but equally or more important how to avoid those complications. And as a surgeon I worry about our IBD patients sometimes more than any other patient I operate on in terms of their risk for complications and the impact that those complications have not only on their postoperative care or postoperative life but their long-term quality of life and quality of health.

The best way to manage these complications is together with surgeons and gastroenterologists together. The earlier I get involved in a patient's care, even before they might need surgery, the better. I'm able to speak with them and meet them and form a relationship with them, even if they don't immediately need surgery. I can get to know them so they're comfortable with the idea of surgery should they need it. And then I can help work with the team to try to minimize those risks of surgery and to really help to choose that sweet spot between the time when medical management is not going to get us to where we want to be and when surgery is needed. And the more we can hit that sweet spot with these patients in surgery I think the better the patients do. So it's so important to work together to take care of these patients because the risks are so high. And then in the perioperative period we have great strategies for taking care of patients with IBD after surgery.

We've really studied about their characteristic risks or the specific complications that they're higher risk for after surgery and are still learning a lot about how to manage these appropriately.

We talked about 5 things that I worry about in IBD patients in particular that I always pay attention to in the perioperative period.

The first is an anastomotic leak after surgery and we talked about how we manage that in the hospital and the things that we can do to shorten the hospital stay or prevent that patient from having a long-term complication of that anastomosis.

We also talked about wound healing, the importance of reducing the risk of poor wound healing before surgery, weaning steroids as much as we can, offering the patient surgery in a timely fashion before they get very sick, so that they can heal appropriately.

We talked about the increased risk for venous thromboembolism in our patients and how nowadays we're actually sending patients home on prophylactic medication for several weeks after surgery to reduce this increased risk in these patients.

And we also talked about the role of ileostomy management after surgery in these patients. So many of these patients are at increased risk for having a temporary or permanent ileostomy and this is a big factor in patients who are readmitted into the hospital after surgery. So we talked about the strategy of including and involving a wound and ostomy nurse early in the patient's care, even before surgery occurs, and providing them education and close monitoring to avoid high-output ileostomy dehydration or pouching issues.

So we were able to talk about the guidelines that we follow now to get IBD patients safely and successfully through the perioperative period and new areas that we're studying currently to learn even more about this, so our patients do even better.