Aurélien Venara1,2,3,4, Pascal Alfonsi5, Eddy Cotte6,7, Jérôme Loriau8, Jean-François Hamel9,10, Karem Slim11. 1. Department of Visceral Surgery, CHU of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France. auvenara@chu-angers.fr. 2. UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, 1, rue Gaston Veil, 44035, Nantes, France. auvenara@chu-angers.fr. 3. LUNAM, University of Angers, Angers, France. auvenara@chu-angers.fr. 4. HIFIH Laboratory (UPRES 3859), University of Angers, ULB, 49035, Angers, France. auvenara@chu-angers.fr. 5. Department of Anesthesiology, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France. 6. Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, Université de Lyon, 69495, Pierre-Bénite Cedex, France. 7. Faculty of medicine Lyon-Sud/ Charles Mérieux, 69921, Oullins Cedex, France. 8. Department of Visceral Surgery, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France. 9. LUNAM, University of Angers, Angers, France. 10. Department of Methodology and Biostatistics, CHU Angers, 49933, Angers Cedex 9, France. 11. Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont Ferrand, France.
Abstract
PURPOSE: Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery. METHODS: This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required. RESULTS: Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30-6.28), urinary retention (OR = 1.75; 95% CI: 1.05-2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04-9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15-8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74-8.88 and OR = 5.76; 95% CI: 3.56-10.62). CONCLUSION: Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.
PURPOSE: Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery. METHODS: This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required. RESULTS: Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30-6.28), urinary retention (OR = 1.75; 95% CI: 1.05-2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04-9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15-8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74-8.88 and OR = 5.76; 95% CI: 3.56-10.62). CONCLUSION: Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.
Authors: Jean F Hamel; Charles Sabbagh; Arnaud Alves; Jean M Regimbeau; Timothée Vignaud; Aurélien Venara Journal: Sci Rep Date: 2021-04-01 Impact factor: 4.379