Cindy Y Teng1, Sara Myers1, Tanya S Kenkre2, Luke Doney3, Wai Lok Tsang4, Kathirvel Subramaniam5, Stephen A Esper5, Jennifer Holder-Murray6,7. 1. Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. 2. Epidemiology Data Center Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 3. Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL, USA. 5. Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 6. Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. holdermurrayjm@upmc.edu. 7. Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. holdermurrayjm@upmc.edu.
Abstract
BACKGROUND: Postoperative ileus occurs in up to 30% of colorectal surgery patients and is associated with increased length of stay, costs, and morbidity. While Enhanced Recovery Protocols seek to accelerate postoperative recovery, data on modifiable preoperative factors associated with postoperative ileus in this setting are limited. We aimed to identify preoperative predictors of postoperative ileus following colorectal surgery in Enhanced Recovery Protocols, to determine new intervention targets. METHODS: We performed a retrospective single-center cohort study of patients ≥ 18 years old who underwent colorectal surgery via Enhanced Recovery Protocols (7/2015-7/2017). Postoperative ileus was defined as nasogastric tube insertion postoperatively or nil-per-os by postoperative day 4. Preoperative risk factors including comorbidities and medication use were identified using multivariable stepwise logistic regression. RESULTS: Of 530 patients, 14.9% developed postoperative ileus. On univariate analysis of perioperative and postoperative factors, postoperative ileus patients had increased psychiatric illness, antidepressant and antipsychotic use, American Society of Anesthesiologists classification, ileostomy creation, postoperative opioid use, complications, surgery duration, and length of stay (p < 0.05). Multivariable logistic regression model for preoperative factors identified psychiatric illness, preoperative antipsychotic use, and American Society of Anesthesiologists classification ≥ 3 as significant predictors of postoperative ileus (p < 0.05). DISCUSSION: Postoperative ileus remains a common complication following colorectal surgery under Enhanced Recovery Protocols. Patients with pre-existing psychiatric comorbidities and preoperative antipsychotic use may be a previously overlooked cohort at increased risk for postoperative ileus. Additional research and preoperative interventions within Enhanced Recovery Protocols to reduce postoperative ileus for this higher-risk population are needed.
BACKGROUND: Postoperative ileus occurs in up to 30% of colorectal surgery patients and is associated with increased length of stay, costs, and morbidity. While Enhanced Recovery Protocols seek to accelerate postoperative recovery, data on modifiable preoperative factors associated with postoperative ileus in this setting are limited. We aimed to identify preoperative predictors of postoperative ileus following colorectal surgery in Enhanced Recovery Protocols, to determine new intervention targets. METHODS: We performed a retrospective single-center cohort study of patients ≥ 18 years old who underwent colorectal surgery via Enhanced Recovery Protocols (7/2015-7/2017). Postoperative ileus was defined as nasogastric tube insertion postoperatively or nil-per-os by postoperative day 4. Preoperative risk factors including comorbidities and medication use were identified using multivariable stepwise logistic regression. RESULTS: Of 530 patients, 14.9% developed postoperative ileus. On univariate analysis of perioperative and postoperative factors, postoperative ileus patients had increased psychiatric illness, antidepressant and antipsychotic use, American Society of Anesthesiologists classification, ileostomy creation, postoperative opioid use, complications, surgery duration, and length of stay (p < 0.05). Multivariable logistic regression model for preoperative factors identified psychiatric illness, preoperative antipsychotic use, and American Society of Anesthesiologists classification ≥ 3 as significant predictors of postoperative ileus (p < 0.05). DISCUSSION: Postoperative ileus remains a common complication following colorectal surgery under Enhanced Recovery Protocols. Patients with pre-existing psychiatric comorbidities and preoperative antipsychotic use may be a previously overlooked cohort at increased risk for postoperative ileus. Additional research and preoperative interventions within Enhanced Recovery Protocols to reduce postoperative ileus for this higher-risk population are needed.
Authors: Laura Z Hyde; James Mark Kiely; Ahmed Al-Mazrou; Haiqing Zhang; Steven Lee-Kong; Ravi Pokala Kiran Journal: Dis Colon Rectum Date: 2019-06 Impact factor: 4.585
Authors: Sebastiano Nazzani; Marco Bandini; Felix Preisser; Elio Mazzone; Michele Marchioni; Zhe Tian; Robert Stubinski; Maria Chiara Clementi; Fred Saad; Shahrokh F Shariat; Emanuele Montanari; Alberto Briganti; Luca Carmignani; Pierre I Karakiewicz Journal: Surg Oncol Date: 2019-01-29 Impact factor: 3.279
Authors: A Venara; H Meillat; E Cotte; M Ouaissi; E Duchalais; C Mor-Martinez; A Wolthuis; J M Regimbeau; S Ostermann; J F Hamel; J Joris; K Slim Journal: World J Surg Date: 2020-03 Impact factor: 3.352