Risk factors associated with prolonged postoperative ileus after elective colon resection

Juárez-Parra, M.A.; Carmona-Cantú, J.; González-Cano, Juan Roberto; Arana-Garza, Sebastian; Treviño-Frutos, Ramón Javier

doi:10.1016/j.rgmxen.2015.08.013

Cited by 10 publications

(16 citation statements)

References 8 publications

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“…A systematic review and global survey proposed that PPOI is best defined as ileus that occurs 96 h after surgery based on the results of the previous literature, which has been acknowledged by many investigators[7]. PPOI is a frequent com-plication of abdominal surgery that results in severe disease burden and pain[8,9]. A multicenter survey of 17876 patients undergoing colectomy showed that the frequency of PPOI was 15.3%, which prolonged hospitalization and increased health care resource utilization[10].…”

Section: Introductionmentioning

confidence: 99%

Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer

Liang

Zhang

Cui

et al. 2019

WJG

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BACKGROUNDProlonged postoperative ileus (PPOI) is one of the common complications in gastric cancer patients who underwent gastrectomy. Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI. We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIMTo investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODSBetween June 2016 and March 2017, the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database. Clinical data of patients who fulfilled the criteria were obtained. Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI. A nomogram for PPOI was developed and verified by bootstrap resampling. The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve. The clinical usefulness of our model was evaluated using the net benefit curve.RESULTSThis study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy. The incidence of PPOI was 19.75% in patients with gastrectomy. Age older than 60 years, open surgery, advanced stage (III–IV), and postoperative use of opioid analgesic were independent risk factors for PPOI. We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy. This nomogram had an excellent diagnostic performance [area under the curve (AUC) = 0.836, sensitivity = 84.4%, and specificity = 75.4%]. This nomogram was further validated by bootstrapping for 500 repetitions. The AUC of the bootstrap model was 0.832 (95%CI: 0.741–0.924). This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSIONWe have developed a prediction nomogram of PPOI for gastric cancer. This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.

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Section: Introductionmentioning

confidence: 99%

Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer

Liang

Zhang

Cui

et al. 2019

WJG

View full text Add to dashboard Cite

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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%

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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“…Similar rate of 12.7% was reported by Moghadamyeghaneh et al 17 , although studies are hard to compare since they were different in design and definition of prolonged postoperative ileus. Retrospective study by Juarez-Parra et al 18 used the same definition of PPOI but with reported incidence almost twice higher (22.3%), even though some of the patients were operated by laparoscopic approach. Some authors argue that after laparoscopic surgery faster bowel recovery is to be expected because there is less surgical trauma, reduction in release operative stress hormones, less postoperative pain with the reduction in need for analgetics.…”

Section: Discussionmentioning

confidence: 99%

Prolonged postoperative ileus after elective colorectal cancer surgery

Nestorović¹,

Stanojević²,

Branković³

et al. 2018

VOJNOSANIT PREGL

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Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (2 = 34.966; p < 0.001), complications grade III (2 = 23.43; p < 0.001) and reoperations (2 = 15.724; p <0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.

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Risk factors associated with prolonged postoperative ileus after elective colon resection

Cited by 10 publications

References 8 publications

Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer

Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer

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

Prolonged postoperative ileus after elective colorectal cancer surgery

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