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Crohn’s disease (CD) is an idiopathic, chronic inflammatory bowel disease that leads to lifelong morbidity and decreased quality of life. In the Netherlands, over 40.000 patients are diagnosed with CD. Approximately 70% of CD patients require intestinal resection within 10 years after diagnosis. Unfortunately, intestinal resection is not a definitive (curative) treatment, and 40 to 80% of patients will undergo repeated surgery for CD recurrence. For many patients, an intestinal resection is a major life event, which on the one hand will relieve the symptoms of the bowel disease immediately, while on the other hand it causes concerns of complications and disrupts the normal daily life functioning of patients due to the necessity of hospitalization and postoperative recovery. Multimodal prehabilitation prior to CD surgery aims to enhance perioperative patient condition and daily functioning, known to improve postoperative recovery, and to reduce the risks of post-operative complications. The multimodal prehabilitation requires an interdisciplinary approach tailored with an individual patient and his/her social support system. In the first phase of the PRECEDE project, we aim to 1. Identify which general and disease and patient specific pre-operative factors influence the postoperative course after intestinal resection in CD patients; 2.Develop an evidence-based management multimodal prehabilitation PRECEDE algorithm, including modifiable pre-operative factors; 3. Design a trial to assess whether standardized care through the implementation of the PRECEDE algorithm of combined interventions for CD patients results in an improvement of post-operative outcome, with regard to enhanced recovery and patient performed daily functioning and reported quality of life, perioperative prognosis (length of resected intestinal segment, duration of operation, duration of hospitalization, recovery progress of daily functioning), postoperative complications (infections, pain, reintervention), long-term prognosis (endoscopic CD recurrence after 6 months), and direct and indirect health care costs.

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