Risk factors for postoperative ileus following elective laparoscopic right colectomy: a retrospective multicentric study

Courtot, L.; Roy, Bertrand Le; Memeo, R.; Voron, Thibault; Angelis, Nicolas de; Tabchouri, Nicolas; Brunetti, Francesco; Berger, Anne; Mutter, Didier; Gagnière, Johan; Salamé, Ephrem; Pezet, Denis; Ouaïssi, Mehdi

doi:10.1007/s00384-018-3070-2

Cited by 18 publications

(24 citation statements)

References 31 publications

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“…The higher incidence of other postoperative complications associated with PPOI, such as cardiac and pulmonary complications, have also been reported in previous studies 16,30 . The association between PPOI and urinary tract infections, however, has not been reported previously, and may be due to longer periods with an indwelling catheter to manage fluid balance.…”

Section: Discussionsupporting

confidence: 61%

“…27 The finding that orientation of the anastomosis (side-to-side) was a riskfactor for PPOI in the univariate analysis has also been found by Lee et al who showed higher rates of PPOI and other complications in patients who received a side-to-side anastomosis after a laparoscopic right hemicolectomy. 29,30 In the present study right hemicolectomies were performed equally in both groups, but the identified risk-factor of orientation of the anastomosis could be related to the higher rate of reversal of loop ileostomies and the lower rate of left colectomies/high anterior resections in the ileus group, considering the impact on ileus of the recto-sigmoid brake, which is no longer present in these patients. 31 Opioid administration was identified as an independent predictor of PPOI.…”

Section: Discussionmentioning

confidence: 62%

“…37 The higher incidence of other postoperative complications associated with PPOI, such as cardiac and pulmonary complications, have also been reported in previous studies. 16,30 The association between PPOI and urinary tract infections, however, has not been reported previously, and may be due to longer periods with an indwelling catheter to manage fluid balance. In the future, the identified peri-operative PPOI risk-factors from the current and subsequent studies may allow surgeons and anaesthesiologists to mitigate risks of these complications, potentially by intraoperatively modifying these risk-factors.…”

Section: Discussionmentioning

confidence: 97%

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A snapshot of intraoperative conditions to predict prolonged postoperative ileus after colorectal surgery

Fortman

Kroon

Bedrikovetski

et al. 2022

ANZ Journal of Surgery

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Background The cause of prolonged postoperative ileus (PPOI) is multifactorial. The influence of preoperative factors on PPOI has been well documented, but little is known about the impact of intraoperative conditions. The aim of this study was to investigate the influence of intraoperative factors on PPOI in patients undergoing colorectal surgery. Methods The LekCheck study database of the Colorectal Unit at the Royal Adelaide Hospital was analysed. Per patient, over 60 data points were prospectively collected between March 2018 and July 2020. Intraoperative data were collected in theatre during a one‐off snapshot measure. Univariate and multivariable logistic regression analyses were performed. Results Data of 336 patients were included. The median age was 66 years and 58.3% were male. Ninety‐three patients (27.7%) developed PPOI. Univariate analysis identified the following intraoperative variables as risk‐factors of PPOI: greater volumes of intraoperative IV fluid administration (464 versus 415 mL/h for those without PPOI; p = 0.04), side‐to‐side anastomosis orientation (53.8 versus 41.2%; p = 0.04) and increased perioperative opioid use (6.73 versus 4.11 mg/kg morphine equivalents for patients with and without PPOI, respectively; p = 0.02). Upon multivariable analysis, increased perioperative opioid use remained significant (p = 0.05), as well as the preoperative factors anticoagulation use (p = 0.04) and higher levels of serum total protein (p = 0.02). Conclusion This study suggests that intraoperative factors may also contribute to the development of PPOI, but this could not be confirmed in the multivariate analysis. Further studies including larger patient numbers will be required to determine the impact of intraoperative conditions on the development of PPOI.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 97%

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A snapshot of intraoperative conditions to predict prolonged postoperative ileus after colorectal surgery

Fortman

Kroon

Bedrikovetski

et al. 2022

ANZ Journal of Surgery

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“…20 Prolonged ileus is a postoperative morbidity observed in approximately 10-27% of patients following colorectal surgery. 2,[21][22][23][24][25] All cohorts examined in this study fell within or just below this predicted range. However, the CD patients may have an increased rate of PPOI under ERAS, seen with the trend between the CD cohorts in Table 2.…”

Section: Discussionmentioning

confidence: 58%

The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

Croasdale

Olutola

et al. 2020

The American Surgeon

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Background Enhanced recovery after surgery (ERAS) protocols are widely employed in colorectal surgery, successful in reducing postoperative morbidities and hospital length of stay (LOS). However, ERAS effects on the inflammatory bowel disease population remain unclear. This study examines the postoperative course of both Crohn’s disease (CD) and colon cancer (CC) patients after elective right hemicolectomies and compares the effectiveness of ERAS protocol. Methods A retrospective analysis was performed on patients with CD and CC undergoing elective right hemicolectomies and ileocecectomies from January 2014 through June 2016 (pre-ERAS) and January 2017 through April 2019 (post-ERAS) from a single tertiary care center. Patient demographics and perioperative variables were examined, including prolonged postoperative ileus (PPOI), hospital LOS, and 30-day readmission. Results 98 CC patients and 91 CD patients met the inclusion criteria. The pre-ERAS CC and post-ERAS CC cohorts were significantly different: post-ERAS had fewer patients with congestive heart failure and chronic obstructive pulmonary disease and had higher albumin levels. The pre-ERAS CC cohort had significantly longer operative durations and higher rates of concomitant procedures than the post-ERAS CC cohort. Both patients with CC and CD had a reduction in LOS with implementation of ERAS, decreasing by 2.24 days ( P = .002) and 1.21 days ( P = .038), respectively. There was a reduction in rates of organ space infections with CD (pre .132, post .00, P = .007). There was a trend towards an increased rate of PPOI with CD (Pre .079, Post .226, P = .062). Discussion The ERAS protocol significantly reduced LOS for both groups, without increasing 30-day readmission rates or other morbidities.

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“…Site and type of surgery was found related to postoperative ileus [4]. Other significant factors related to post-operative ileus are age, gender, tumor location, comorbidities (coagulopathy and chronic obstructive pulmonary disease), blood transfusion and fluid infusion intraoperative, type of anesthesia and analgesics, other post-operative complication and previous history of surgery [1], [6]. However, it is hard to find same study conducted in Indonesia.…”

Section: Introductionmentioning

confidence: 96%

Risk Factors for Post-operative Ileus: A Retrospective Study in Tertiary Referral Hospital in Indonesia

Sueta

Golden

Prawira

2022

Open Access Maced J Med Sci

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Background: Postoperative ileus is a complication that may result in the longer duration of stay and decreases the quality of life of patients. Previous studies have found some factors related to postoperative ileus. This study aimed to determine the risk factor of postoperative ileus in laparotomic resection and anastomosis surgery. Methods: Patients who underwent laparotomic resection and anastomosis surgery during January 2019 – July 2020 were included. Postoperative ileus was diagnosed in fourth day after surgery. The variables included in this study are age, gender, BMI, pathology site, duration of surgery, type of anastomosis, length of resection. Result: Fifty laparotomic resection and anastomosis surgery patients were included in this study, 50% of subjects is patients with postoperative ileus. Patient aged 65 years old or older had a higher incidence postoperative ileus (68% vs 28%; RR 2.3 95% CI: 1.23-4.33; p value: 0.010). Study also found duration of surgery 180 minutes or longer also had higher incidence postoperative ileus (79% vs 36%; RR: 2.49 95% CI: 1.20-5.15; p value: 0.010). Conclusion: This study concludes that age 65 years old or older and duration of surgery 180 minutes or longer are significant risk factor to postoperative ileus in laparotomic resection and anastomosis surgery patients.

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Risk factors for postoperative ileus following elective laparoscopic right colectomy: a retrospective multicentric study

Abstract: This study is one of the first to explore the CLIHMET database and the first to use it for investigating risk factors for POI development. Modifiable risk factors such as epidural anaesthesia and intraoperative blood transfusion should be used with caution in order to decrease POI rates.

Cited by 18 publications

References 31 publications

A snapshot of intraoperative conditions to predict prolonged postoperative ileus after colorectal surgery

A snapshot of intraoperative conditions to predict prolonged postoperative ileus after colorectal surgery

The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

Risk Factors for Post-operative Ileus: A Retrospective Study in Tertiary Referral Hospital in Indonesia

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