Prolonged Postoperative Ileus—Definition, Risk Factors, and Predictors after Surgery

Artinyan, Avo; Nunoo‐Mensah, Joseph W.; Balasubramaniam, Swarna; Gauderman, Jim; Essani, Rahila; Gonzalez-Ruiz, Claudia; Kaiser, Andreas M.; Beart, Robert W.

doi:10.1007/s00268-008-9491-2

Cited by 242 publications

(202 citation statements)

References 26 publications

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“…Although these pharmacological agents reduce ileostomy output, they are not commonly used in perioperative HOI treatment, as the perioperative use of opioids has been shown to increase the risk of ileus (11). It has been reported that Clostridium difficile (C. difficile) infection often occurs in HOI (12); however, C. difficile was not detected in our cases (data not shown).…”

Section: Discussioncontrasting

confidence: 52%

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Fujino

Miyoshi

Ohue

et al. 2017

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to examine the risk factors of high-output ileostomy (HOI), which is associated with electrolyte abnormalities and/or stoma complications, and to create a prediction model. The medical records of 68 patients who underwent colorectal cancer surgery with ileostomy between 2011 and 2016 were retrospectively investigated. All the patients underwent surgical resection for colorectal cancer at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan). A total of 7 patients with inadequate data on ileostomy output were excluded. Using a group of 50 patients who underwent surgery between 2011 and 2013, the risk of HOI was classified by a decision tree model using a partition platform. The HOI prediction model was validated in an additional group of 11 patients who underwent surgery between 2014 and 2016. Univariate analysis of clinical factors demonstrated that young age (P=0.003) and high white blood cell (WBC) count (P<0.001) after surgery were significantly correlated with HOI. Operative factors, such as surgical procedure, approach, operative time and blood loss, were not significantly correlated with HOI. Using these clinical factors, the risk of HOI was classified by statistical partition. In this model, three factors (gender, age and WBC on postoperative day 1) were generated for the prediction of HOI. The patients were classified into five groups, and HOI was observed in 0-88% of patients in each group. The area under the curve (AUC) was 0.838. The model was validated by an external dataset in an independent patient group, for which the AUC was 0.792. In conclusion, HOI patients were classified and an HOI prediction model was developed that may help clinicians in postoperative care. IntroductionSurgery is an effective treatment for colorectal cancer (CRC) (1,2), and certain procedures, such as low anterior resection and intersphincteric resection for lower rectal cancer, require an ileostomy to reduce the risk of severe anastomotic leakage (3-5). High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6-8).The aim of the present study was to determine the frequency and risk factors of HOI and to create a prediction model of HOI. Predicting HOI may be useful for perioperative treatment. Patients and methodsPatients and data sets. A total of 68 consecutive patients who underwent surgery for colorectal cancer with ileostomy at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) between 2011 and 2016 were retrospectively analyzed. HOI was defined by a maximum output of >2,000 ml/day and high output (>1,000 ml/day) lasting for >3 days (Fig. 1). A total of 7 patients for whom detailed data of output were unavailable were excluded (Fig. 2). Based on a group of 50 patients who underwent surgery between 2011 and 2013, a decision tree was used to develop a prediction model for HOI. Clinicopathological factors, such as patient sex, age, body mass index, tumor stage, pr...

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Section: Discussioncontrasting

confidence: 52%

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Fujino

Miyoshi

Ohue

et al. 2017

Molecular and Clinical Oncology

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“…Other accelerated recovery pathways have shown benefits of pain control with multimodal 28 and regional 29 -32 analgesia. As opioid requirements have been identified as one of two independent risk factors for prolonged postoperative ileus, any pathway that minimizes use of opioids should decrease the risk of ileus 33 . The other risk, estimated blood loss, may be less modifiable 33 .…”

Section: Discussionmentioning

confidence: 99%

Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery

Lovely¹,

Maxson

Jacob³

et al. 2011

British Journal of Surgery

110

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“…However, the applicability of a retrospective analysis might greatly vary in different centers, depending on patients' characteristics. For instance, none of the three independent risk factors in this scoring system reached significance in the analyses from other databases [38,39,40]. Different centers, therefore, need to consider or even reevaluate the applicability of the predictive scoring systems from other databases.…”

Section: Discussionmentioning

confidence: 99%

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Wu¹,

Boersema²,

Dereci³

et al. 2014

Eur Surg Res

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Background: This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI). Methods: Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized. Results: Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-α might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c). Conclusions: Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need. © 2014 S. Karger AG, Basel

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Prolonged Postoperative Ileus—Definition, Risk Factors, and Predictors after Surgery

Cited by 242 publications

References 26 publications

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

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