Men and Those With a History of Smoking Are Associated With the Development of Postoperative Ileus Following Elective Colorectal Cancer Resection at a Private Academic Hospital in Johannesburg, South Africa: A Retrospective Cohort Study

Abstract

Introduction: A scarcity of local published data on colorectal cancer (CRC) postoperative complications, including postoperative ileus (POI), exists. POI is a temporary gastrointestinal (GI) state of absent or reduced gastric motility shown to increase patient morbidity, prolong length-of-stay (LOS), and intensify the healthcare resource burden. The pathogenesis of POI involves a neurogenic and inflammatory phase plus a pharmacological component.Aim and Objectives: This study aimed to determine centre-specific preoperative risk factors associated with the development of ileus post elective therapeutic CRC resection. The objectives were to determine whether patient demographics; functional status; comorbidities; GI history; pharmacotherapy (including neoadjuvant chemotherapy); and lastly neoadjuvant radiation and chemoradiation were associated with the development of POI.Method: Patients who underwent CRC resection between January 2016 and May 2019 were retrospectively identified from an existing database. Urgent—or non-therapeutic surgeries; surgeries with the complication anastomotic leak or GI obstruction; patients under 18 at the time of surgery or surgeries preceded by preoperative parenteral nutrition were excluded. A comparison was done of the incidence of exposure in the study cohort to investigated variables as potential risk factors for the complication POI.Results: A total of 155 patient cases were included, and 56 (36%) of them developed POI. Univariate comparison of patients who developed POI with demographic characteristics of patients who did not suggested that women were at lower risk to develop POI compared to men (p = 0,013; RR 0,56; 95% CI 0,36–0,89). Functional status suggested that all previous smokers were at a higher risk to develop POI compared to lifetime non-smokers (p = 0,0069; RR 1,78; 95% CI 1,17–2,70). Multivariable comparison of ≤ 5 qualifying parameters showed no significance.Conclusion: The high local incidence of POI in this patient population shows that intervention is required to reduce the POI rate and improve postoperative outcomes. This study suggests that for men and all patients with a history of smoking both, CRC resection preoperative recommendations with the intention to prevent POI should include instructions initiating the activation of preventive strategies like the Enhanced Recovery After Surgery (ERAS) programme. More studies are needed to adequately determine local perioperative risk factors for POI.

Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery: A meta-analysis

“…A total of 922 literatures were obtained through the initial examination of the database; 130 literatures were supplemented by other means; 102 duplicated literatures were removed; 125 literatures that were obviously inconsistent with the theme were excluded by reading the abstract and title; 30 literatures were included in the preliminary screening; 7 literatures were excluded after reading the full text; and the full text was carefully read according to the inclusion and exclusion criteria. Finally, a total of 23 eligible pieces of literature were included[ 4 , 8 - 29 ]. The specific literature screening process is shown in Figure 1 .…”

“…A total of 23 cohort studies were included[ 4 , 8 - 29 ], with a total sample size of 43878 cases and 5300 cases of POGD, and the incidence of POGD ranged from 4.5% to 71.2 percent. The NOS scores of the included literature were all ≥ 7 points, and the quality of the literature met the requirements (Figure 2 ).…”

“…Prolong the hospital stay of patients and increase the economic burden of patients. Studies[ 4 - 6 ] have shown that almost all medium and above surgery (especially abdominal surgery), anesthesia, fluid load, analgesic drugs, postoperative inflammatory response, etc ., will have varying degrees of influence on postoperative gastrointestinal function. Among them, the incidence of POGD after abdominal surgery ranges from 4% to 32%, and the incidence of gastrointestinal surgery is even higher.…”

Predicting perioperative outcomes of robot‐assisted radical cystectomy: Data from the Asian Robot‐Assisted Radical Cystectomy Consortium

“…However, tobacco usage has been independently associated with prolonged recovery from ileus after major abdominal surgery and poorer intestinal function after bowel anastomoses. 19,20 The adverse impact of smoking may be related to tissue hypoxia, mucosal cell damage, and an impairment in mucosal cellular renewal. 21 In this study, the assessment of the differential impact of smoking on ileus is limited by patient reporting of smoking status prone to recall bias (duration of smoking cessation prior to surgery, cumulative exposure to tobacco).…”

“…These previous analyses may have been limited by low proportions of nonsmokers in the study cohorts, thereby limiting analytical insight on the effect of smoking. However, tobacco usage has been independently associated with prolonged recovery from ileus after major abdominal surgery and poorer intestinal function after bowel anastomoses 19,20 . The adverse impact of smoking may be related to tissue hypoxia, mucosal cell damage, and an impairment in mucosal cellular renewal 21 .…”