Aurélien Venara1,2,3, Karem Slim4, Jean-Marc Regimbeau5, Pablo Ortega-Deballon6, Bruno Vielle7, Emilie Lermite8,9, Guillaume Meurette10,11, Antoine Hamy8,9. 1. Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933 Cedex 9, Angers, France. auvenara@yahoo.fr. 2. LUNAM, University of Angers, Angers, France. auvenara@yahoo.fr. 3. UMR INSERM U1235 - TENS, School of Medicine University of Nantes, 1 rue Gaston Veil, 44035, Nantes, France. auvenara@yahoo.fr. 4. Department of Visceral Surgery, CHU Estaing, Clermont Ferrand, France. 5. Visceral and Endocrinal Surgery Department, University Hospital of Amiens, Amiens, France. 6. Department of Digestive and Endocrine Surgical Oncology, University Hospital of Dijon, Dijon, France. 7. Department of Biostatistics, University Hospital of Angers, Angers, France. 8. Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933 Cedex 9, Angers, France. 9. LUNAM, University of Angers, Angers, France. 10. UMR INSERM U1235 - TENS, School of Medicine University of Nantes, 1 rue Gaston Veil, 44035, Nantes, France. 11. Visceral and Endocrinal Surgery Department, University Hospital of Nantes, 1 rue Gaston Veil, 44035, Nantes Cedex, France.
Abstract
PURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification. METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons. RESULTS: A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations. CONCLUSION: This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.
PURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification. METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons. RESULTS: A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations. CONCLUSION: This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.
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