Prolonged Postoperative Ileus Significantly Increases the Cost of Inpatient Stay for Patients Undergoing Elective Colorectal Surgery: Results of a Multivariate Analysis of Prospective Data at a Single Institution

Mao, Howe; Milne, Tony; O’Grady, Gregory; Vather, Ryash; Edlin, Richard; Bissett, Ian

doi:10.1097/dcr.0000000000001301

Cited by 67 publications

(87 citation statements)

References 29 publications

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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%

“…A global survey and systematic review extracted definitions from 52 identified trials and proposed 4 days as a standardized endpoint for PPOI . It was well accepted in subsequent studies, and we also adopted this definition as diagnostic criteria in our study . Given the variability in the definitions of this significant complication, further research is necessary to establish a more precise, validated definition.…”

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%

“…If the symptoms persist for more than 4 days, prolonged postoperative ileus (PPOI) is defined . PPOI was an essential contributor to the prolonged hospitalization and readmission, increasing substantial physician workload and high costs on the healthcare system . The incidence of PPOI was reported to vary from 3% to 32%, and there were some differences among the sites of abdominal surgery .…”

Section: Introductionmentioning

confidence: 99%

“…2 PPOI was an essential contributor to the prolonged hospitalization and readmission, increasing substantial physician workload and high costs on the healthcare system. 3 The incidence of PPOI was reported to vary from 3% to 32%, and there were some differences among the sites of abdominal surgery. [4][5][6] However, a majority of the previous studies on PPOI were based on patients referred to colonic or rectal resection, and little data existed on gastrectomy.…”

Section: Introductionmentioning

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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“…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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Blanco‐Colino¹,

Chapman²,

Pata³

et al. 2020

Journal of British Surgery

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Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

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Safety of hospital discharge before return of bowel function after elective colorectal surgery

Collaborative

2020

British Journal of Surgery

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Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.

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Prolonged Postoperative Ileus Significantly Increases the Cost of Inpatient Stay for Patients Undergoing Elective Colorectal Surgery: Results of a Multivariate Analysis of Prospective Data at a Single Institution

Cited by 67 publications

References 29 publications

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

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

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Safety of hospital discharge before return of bowel function after elective colorectal surgery

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