Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta‐analysis

Wolthuis, Albert; Bislenghi, Gabriele; Fieuws, Steffen; Overstraeten, Anthony de Buck van; Boeckxstaens, Guy E.; D’Hoore, André

doi:10.1111/codi.13210

Cited by 163 publications

(149 citation statements)

References 73 publications

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“…The perioperative risk factors, operative time and blood loss, were still significant for ileus [30,31] ; however, these incidents did not support the prediction of delirium. In contrast, higher MMSE and lower GDS score correlated with ileus cases [32] , and this finding should be further studied.…”

Section: Discussionmentioning

confidence: 83%

Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment

et al. 2016

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Aims: The study aims to determine whether the Comprehensive Geriatric Assessment (CGA) could predict complications of colorectal cancer (CRC) surgery and identify the problems. So we compared the prognostic value of the CGA with patient characteristics and determined predictive scores. Methods: A total of 156 patients aged 75 years and older, who underwent surgery for CRC at Osaka University Hospital, were enrolled. Each patient was examined by the CGA prospectively, and all postoperative complications were obtained from the medical records. The CGA included the Barthel Index (BI), Vitality Index, instrumental activities of daily living (iADL), Mini-Mental State Examination (MMSE) and Geriatric Depression Score (GDS). All elements were retrospectively compared in patients with or without postoperative complications, including delirium, surgical site infection and ileus. Results: Overall, postoperative complications developed in 76 patients (48.7%). The BI and MMSE were associated with the incidence of complications, and BI, iADL, MMSE and GDS were significantly related with delirium. Multivariate logistic analysis identified the MMSE as a significant determinant of postoperative complications after adjusting for other determined predictive scores including the prognostic nutritional index and performance status. Conclusion: The CGA was a useful predictor of postoperative complications in elderly patients when administered before surgery for CRC.

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Section: Discussionmentioning

confidence: 83%

Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment

et al. 2016

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“…There have been numerous reports on PPOI after colectomy with prediction or post hoc analyses . However, little is known about risk factors of PPOI for patients with gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

“…There have been numerous reports on PPOI after colectomy with prediction or post hoc analyses. 3,17,18,21,22 However, little is known about risk factors of PPOI for patients with gastric cancer. This study analyzed 15 potential factors of PPOI after resection of gastric cancer in 162 patients.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of PPOI was adopted from the results of a systematic review and global survey . The validity of this concept was universally accepted by a variety of investigators . Accordingly, diagnoses of PPOI were identified if two or more of following events after day 4 postoperatively: (a), nausea or vomiting; (b) inability to tolerate an oral diet over the prior 24 hour; (c) absence of flatus over the prior 24 hours; (d) abdominal distension; (e) radiologic confirmation …”

Section: Methodsmentioning

confidence: 99%

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Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

Liang

Zhang

et al. 2019

Cancer Medicine

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Background Prolonged postoperative ileus (PPOI) is a common complication after abdominal surgery, but data about risk factors of PPOI for patients with gastric cancer are rare. We sought to investigate the impact of laparoscopic versus open surgery for PPOI after gastric cancer surgery. Methods A retrospective cohort study was conducted using a registry database consecutively collected from June 2016 to March 2017. PPOI was defined as no bowel function persisting for more than 4 days. Univariate analysis and multiple logistic regression models were performed to investigate risk factors, and stratified analysis was carried out to examine the primary association at different levels of a potential confounding factor. Results A total of 162 patients composed of 63 patients undergoing laparotomy and 99 patients undergoing laparoscopy were enrolled and PPOI was observed in 32 (19.75%) patients. Risk factors significantly correlated with PPOI were as follows: open surgery, older age, late surgical pathologic staging, postoperative use of opioid analgesic, low level of postoperative albumin and serum potassium. Compared to open surgery, the laparoscopic surgery was a strong protective factor for PPOI after adjusting related variables (OR = 0.17, CI: 0.05‐0.52, P = .002). There was an interaction between surgical methods and the postoperative WBC level (P for interaction = .007). In the two group stratified analysis of WBC, laparoscopic surgery had a significant lower risk of PPOI than open group for the patients with WBC counts above the middle level in crude or adjusted models. This result remained significantly in the three group stratified analysis for the patients with WBC counts in the middle and or high tertile groups. Conclusions PPOI is a common postoperative complication of patients after gastrectomy. Laparoscopic surgery is associated with decreased risk of PPOI in gastric surgery. Patients who underwent open surgery and presented with high level of WBC should be cautious with PPOI.

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“…In 2016, Wolthuis and colleagues identified five unique definitions used in previous colorectal RCTs and four used in non-randomized studies [33]. This is despite previous efforts to reach international consensus on standard end-points and definition [34,35].…”

Section: Discussionmentioning

confidence: 99%

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

2018

Colorectal Disease

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Aim The management of postoperative ileus following colorectal surgery remains controversial. It is the commonest complication after elective colorectal resection and is associated with an increased incidence of postoperative adverse events. The prevention and management of postoperative ileus remains unstandardized. This study aims to describe an international profile of gastrointestinal recovery after colorectal surgery and will assess the role of non-steroidal anti-inflammatory drugs, when used as postoperative analgesia, in expediting the return of gastrointestinal function.Methods A multicentre, student-and trainee-led, prospective cohort study will be conducted across both Europe and Australasia. Adult patients undergoing elective colorectal resection during 2-week data collection periods between January and April 2018 will be included. A site-specific questionnaire will capture compliance to Enhanced Recovery after Surgery components at participating centres. The primary outcome is time to gastrointestinal recovery, measured using a composite outcome of bowel function and oral tolerance. The impact of non-steroidal anti-inflammatory drugs on gastrointestinal recovery will be evaluated along with safety data with respect to anastomotic leak, acute kidney injury and complications within 30 days of surgery.Discussion This protocol describes the methodology of an international, observational assessment of gastrointestinal recovery after colorectal surgery. It discusses key challenges and describes how the results will impact on future investigation. The study will be conducted across a large student-and trainee-led collaborative network, with prospective quality assurance and data validation strategies.

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Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta‐analysis

Abstract: There is a large variation in the reported incidence of PPOI. A uniform definition of PPOI is needed to allow meaningful inter-study comparisons and to evaluate strategies to prevent PPOI.

Cited by 163 publications

References 73 publications

Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment

Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment

Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

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