A Venara1,2,3, H Meillat4, E Cotte5,6, M Ouaissi7, E Duchalais8,9, C Mor-Martinez10, A Wolthuis11, J M Regimbeau12, S Ostermann13, J F Hamel14, J Joris15, K Slim16. 1. Faculty of Medicine of Angers, Angers, France. auvenara@yahoo.fr. 2. Department of Visceral and Endocrinal Surgery (Service de chirurgie viscérale et endocrinienne), CHU Angers, 4, Rue Larrey, 49933, Angers Cedex 9, France. auvenara@yahoo.fr. 3. 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@yahoo.fr. 4. Institut Paoli-Calmette, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France. 5. Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite Cedex, France. 6. Université de Lyon, Lyon, France. 7. Department of Visceral Surgery, CHU Tours, 2 Boulevard Tonnelé, 37000, Tours, France. 8. 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. 9. Department of Visceral Surgery, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France. 10. Department of Visceral Surgery, Clinique de l'Alliance, 1 Boulevard A Nobel, 37540, Saint Cyr Sur Loire, France. 11. Department of Abdominal Surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium. 12. Department of Visceral Surgery, CHU Amiens, Avenue Laennec, 80054, Amiens, France. 13. Hirslanden Clinique La Colline, Geneva, Switzerland. 14. Department of Methodology and Biostatistics, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France. 15. Department of Anesthesiology, CHU Liège, Domaine de Sart Tilman, Université de Liège, 4000, Liege, Belgium. 16. Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France.
Abstract
BACKGROUND: Defining severe postoperative ileus in terms of consequences could help physicians standardize the management of this condition. The recently described classification based on consequences requires further investigation. The aim of this study was to obtain a snapshot of postoperative ileus in patients undergoing colorectal surgery within enhanced recovery programs and to identify factors associated with non-severe and severe postoperative ileus. METHODS: This prospective registry data analysis was conducted in 40 centers in five different countries. A total of 786 patients scheduled for colorectal surgery within enhanced recovery programs were included. The primary endpoint was the incidence rate of postoperative ileus as defined by Vather et al. RESULTS: A total of 121 patients experienced postoperative ileus (15.4%). Non-severe POI occurred in 48 patients (6.1%), and severe postoperative ileus occurred in 73 patients (9.3%). In multivariate analysis, the male gender and intra-abdominal complications were associated with severe postoperative ileus: odd ratio (OR) = 2.03 [95% confidence interval (CI) 1.14-3.59], p = 0.01 and OR = 3.60 [95% CI 1.75-7.40], p < 0.0001, respectively. Conversely, open laparotomy and urinary retention were associated with non-severe POI: OR = 3.03 [95% CI 1.37-6.72], p = 0.006 and OR = 2.70 [95% CI 0.89-8.23], p = 0.08, respectively. CONCLUSIONS: Postoperative ileus occurred in 15% of patients after colorectal surgery within enhanced recovery programs. For 60% of patients, this was considered severe. The physiopathology of these two entities could be different, severe POI being linked to intraabdominal complication, while non-severe POI being linked with risk factors for "primary" POI. The physician should pay attention to male patients having POI after colorectal surgery and look for features evocating intraabdominal complications.
BACKGROUND: Defining severe postoperative ileus in terms of consequences could help physicians standardize the management of this condition. The recently described classification based on consequences requires further investigation. The aim of this study was to obtain a snapshot of postoperative ileus in patients undergoing colorectal surgery within enhanced recovery programs and to identify factors associated with non-severe and severe postoperative ileus. METHODS: This prospective registry data analysis was conducted in 40 centers in five different countries. A total of 786 patients scheduled for colorectal surgery within enhanced recovery programs were included. The primary endpoint was the incidence rate of postoperative ileus as defined by Vather et al. RESULTS: A total of 121 patients experienced postoperative ileus (15.4%). Non-severe POI occurred in 48 patients (6.1%), and severe postoperative ileus occurred in 73 patients (9.3%). In multivariate analysis, the male gender and intra-abdominal complications were associated with severe postoperative ileus: odd ratio (OR) = 2.03 [95% confidence interval (CI) 1.14-3.59], p = 0.01 and OR = 3.60 [95% CI 1.75-7.40], p < 0.0001, respectively. Conversely, open laparotomy and urinary retention were associated with non-severe POI: OR = 3.03 [95% CI 1.37-6.72], p = 0.006 and OR = 2.70 [95% CI 0.89-8.23], p = 0.08, respectively. CONCLUSIONS: Postoperative ileus occurred in 15% of patients after colorectal surgery within enhanced recovery programs. For 60% of patients, this was considered severe. The physiopathology of these two entities could be different, severe POI being linked to intraabdominal complication, while non-severe POI being linked with risk factors for "primary" POI. The physician should pay attention to male patients having POI after colorectal surgery and look for features evocating intraabdominal complications.
Authors: Cindy Y Teng; Sara Myers; Tanya S Kenkre; Luke Doney; Wai Lok Tsang; Kathirvel Subramaniam; Stephen A Esper; Jennifer Holder-Murray Journal: J Gastrointest Surg Date: 2020-11-17 Impact factor: 3.267
Authors: R Nascimbeni; A Amato; R Cirocchi; A Serventi; A Laghi; M Bellini; G Tellan; M Zago; C Scarpignato; G A Binda Journal: Tech Coloproctol Date: 2020-11-05 Impact factor: 3.781