Background Anemia is common before major abdominal surgery (35%). It is an independent factor for postoperative complications and longer length of stay (LOS). The aim of this study was to evaluate the extent to which preoperative anemia impacts on enhanced recovery programs (ERP) outcomes. Materials and MethodsThe data for patients scheduled for colorectal surgery between 2015 and 2019, were analyzed (n = 494). All patients were managed with the same ERP. Demographic data, preoperative risk factors, postoperative complications, LOS and adherence to ERP were compared between anemic and non-anemic patients. Anemia was defined by a hemoglobin concentration \ 13 g dL -1 in men and \ 12 g dL -1 in women. Results and DiscussionIn total, 173 patients had preoperative anemia. They were older (p \ 0.001) and more often male (p = 0.02). The following risk factors were significantly more frequent in the anemic group: renal failure (p = 0.04), malnutrition (p \ 0.001), cardiac arrhythmia (p \ 0.001), coronaropathy (p = 0.02) and anticoagulant treatment (p \ 0.001). Despite more risk factors, anemic patients did not experience more postoperative complications (38.2% vs. 31.2%, p = 0.12). Overall adherence to ERP was similar (18 [16-19] vs. 18 [17-19], p = 0.06). LOS was 4 [3-7] and 3 [2-6.25] days in the anemic and the non-anemic groups, respectively (p \ 0.002). Multivariate analysis showed that anemia did not affect LOS (p = 0.27). Conclusion Our study suggests that preoperative anemia does not detract from the benefits of ERP after elective colorectal surgery.

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Background and aims The abdominal pain common in Inflammatory Bowel Disease (IBD) patients is traditionally associated with inflammation but may persist during clinical remission. Central sensitisation (CS) has never been explored in these patients. This study aimed to determine the epidemiology of pain in IBD patients and to specify pain characteristics with special attention to CS. Methods This cross-sectional study included 200 patients; 67% had Crohn’s disease (CD). Pain was assessed using the McGill questionnaire, the Douleur Neuropathique 4 (DN4) questionnaire, and by clinical examination. Its impacts on the quality of life, depression and anxiety were also assessed. Results Three-quarters of IBD patients complained of pain, including intermittent pain attacks, 62% reported abdominal pain, and 17.5% had CS. Prevalence of pain (83.6% vs. 59.1%; p < 0.001) and abdominal pain (68.7% vs. 48.5%; p = 0.006) was higher in CD patients than in ulcerative colitis (UC) patients. Multivariate analysis confirmed that age (p = 0.02), sex (female) (p = 0.004), and CD (p = 0.005) were independent risk factors for pain. Pain intensity was greater in case of CS (6 [5 - 3] vs. 3 [1.5 - 5], p < 0.003) which significantly impaired quality of life (p < 0.003) compared with pain without CS. Conclusions The prevalence of pain was high in IBD patients (≈75%) and higher in Crohn's patients. Significant impacts on quality of life were confirmed. More than 25% of patients with abdominal pain described CS responsible for more severe pain and worsened quality of life.

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