Gastrointestinal motility has more of an impact on postoperative recovery than you might expect

Viannay, P.; Hamel, Jean‐François; Bougard, M.; Barbieux, J.; Hamy, A.; Venara, Aurélien

doi:10.1016/j.jviscsurg.2020.06.012

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…We speculate that these findings are a result of POI rarely occurring in isolation without other complications. Furthermore, length of stay is strongly predictive of increased hospital costs, likely owing to delayed discharge secondary to complications such as POI contributing to a loss of patient autonomy [11,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Table 2 shows the comparison of postoperative outcomes and complications between the two groups. The non-POI group had a median length of stay of 5 (IQR (3-7), Range ) days compared to 8 (IQR (6)(7)(8)(9)(10)(11), Range ) days in the POI group (p < 0.001).…”

Section: Re Sultsmentioning

confidence: 97%

“…Furthermore, POI leads to higher risk of organ failure (such as renal and hepatic failure), prolongs hospital stay and increases 30-day readmission and mortality rates [2,10]. Furthermore, delayed gastrointestinal recovery such as uncomplicated POI, directly impedes recovery of patient autonomy and subsequent discharge [11]. Preventing POI from occurring could reduce delayed discharges by 33%, readmissions by 21% and mortality by 20% [10].…”

Section: Introductionmentioning

confidence: 99%

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Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

et al. 2022

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Aim Postoperative ileus (POI) following surgery results in significant morbidity, drastically increasing hospital costs. As there are no specific Australian data, this study aimed to measure the cost of POI after colorectal surgery in an Australian public hospital. Methods A cost analysis was performed, for major elective colorectal surgical cases between 2018 and 2021 at the Royal Adelaide Hospital. POI was defined as not achieving GI‐2, the validated composite measure, by postoperative day 4. Demographics, length of stay and 30‐day complications were recorded retrospectively. Costings in Australian dollars were collected from comprehensive hospital billing data. Univariate and multivariate analyses were performed. Results Of the 415 patients included, 34.9% (n = 145) developed POI. POI was more prevalent in males, smokers, previous intra‐abdominal surgery, and converted laparoscopic surgery (p < 0.05). POI was associated with increased length of stay (8 vs. 5 days, p < 0.001) and with higher rates of complications such as pneumonia (15.2% vs. 8.1%, p = 0.027). Total cost of inpatient care was 26.4% higher after POI (AU$37,690 vs. AU$29,822, p < 0.001). POI was associated with increased staffing costs, as well as diagnostics, pharmacy, and hospital services. On multivariate analysis POI, elderly patients, stoma formation, large bowel surgery, prolonged theatre time, complications and length of stay were predictive of increased costs (p < 0.05). Conclusion In Australia, POI is significantly associated with increased complications and higher costs due to prolonged hospital stay and increased healthcare resource utilisation. Efforts to reduce POI rates could diminish its morbidity and associated expenses, decreasing the burden on the healthcare system.

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Section: Discussionmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

et al. 2022

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“…Recovery after abdominal surgery requires patients to tolerate diet, mobilize independently and demonstrate evidence of return of gastrointestinal (GI) function. Delayed recovery of GI function or postoperative ileus (POI) is a major impediment to postoperative recovery [1,2]. Despite the advent of enhanced recovery protocols (ERPs) in the last decade, POI is still common and occurs in almost one in three patients after colorectal surgery [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

PyRICo‐Pilot: pyridostigmine to reduce the duration of postoperative ileus after colorectal surgery – a phase II study

et al. 2021

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Aim: Postoperative ileus (POI) is a major problem after colorectal surgery.Acetylcholinesterase inhibitors such as pyridostigmine increase gastrointestinal (GI) motility through a cholinergic anti-inflammatory pathway. The purpose of this phase II pilot study is to determine the safety of oral pyridostigmine after elective colorectal surgery.Method: This is a Stage 2b safety study (IDEAL framework). All adult patients undergoing elective colorectal resection or formation or reversal of stoma at the Royal Adelaide Hospital between September 2020 and January 2021 were eligible. The primary outcomes were 30-day postoperative complications, reported adverse events and GI-2 -a validated composite outcome measure of recovery of GI function after surgery, defined as the interval from surgery until first passage of stool and tolerance of a solid intake for 24 h (in whole days) in the absence of vomiting.Results: Fifteen patients were included in the study. The median age was 58 (range 50-82) years and seven (47%) were men. Most participants had an American Society of Anesthesiologists grade ≥2 (53%) and the median body mass index was 27 (24-35) kg/ m 2 . There were 13 postoperative complications [seven were Clavien-Dindo (CD) 1, five CD 2 and one CD 3]. None appeared directly related to pyridostigmine administration, and none of the patients had any overt symptoms of excessive parasympathetic activity.Median GI-2 was 2 (1-4) days. Conclusion:Oral pyridostigmine appears to be safe to use after elective colorectal surgery in a select group of patients. However, considering this is a pilot study with a small sample size, larger controlled studies are needed to confirm this finding and establish efficacy for prevention of POI.

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Pre-habilitation before colorectal cancer surgery could improve postoperative gastrointestinal function recovery: a case-matched study

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Dinomais

et al. 2022

Langenbecks Arch Surg

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Gastrointestinal motility has more of an impact on postoperative recovery than you might expect

Cited by 7 publications

References 21 publications

Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

PyRICo‐Pilot: pyridostigmine to reduce the duration of postoperative ileus after colorectal surgery – a phase II study

Pre-habilitation before colorectal cancer surgery could improve postoperative gastrointestinal function recovery: a case-matched study

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