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Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Prolonged postoperative ileus (PPOI) is among the common complications adversely affecting postoperative outcomes. Predictors of PPOI after major abdominal surgery remain unclear, although various PPOI predictors have been reported in patients undergoing colorectal surgery. This study aimed to devise a model for stratifying the probability of PPOI in patients undergoing abdominal surgery.

Methods

Between 2012 and 2013, 841 patients underwent major abdominal surgery after excluding patients who underwent less-invasive abdominal surgery, ileus-associated surgery, and emergency surgery. Postoperative managements were generally based on enhanced recovery after surgery (ERAS) program. The definition of PPOI was based on nausea, no oral diet, flatus absence, abdominal distension, and radiographic findings. A nomogram was devised by evaluating predictive factors for PPOI.

Results

Of the 841 patients, 73 (8.8%) developed PPOI. Multivariable logistic regression analysis revealed smoking history (P = 0.025), colorectal surgery (P = 0.004), and an open surgical approach (P = 0.002) to all be independent predictive factors for PPOI. A nomogram was devised by employing these three significant predictive factors. The prediction model showed relatively good discrimination performance, the concordance index of which was 0.71 (95%CI 0.66–0.77). The probability of PPOI in patients with a smoking history who underwent open colorectal surgery was calculated to be 19.6%.

Conclusions

Colorectal surgery, open abdominal surgery, and smoking history were found to be independent predictive factors for PPOI in patients who underwent major abdominal surgery. A nomogram based on these factors was shown to be useful for identifying patients with a high probability of developing PPOI.

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Abbreviations

ASA:

American Society of Anesthesiologists Physical Status classification system

BMI:

Body mass index

COPD:

Chronic obstructive pulmonary disease

EBL:

Estimated blood loss

eGFR:

Estimated glomerular filtration rate

ERAS:

Enhanced recovery after surgery

IQR:

Interquartile range

PNI:

Prognostic nutritional index

POD:

Postoperative day

PPOI:

Postoperative prolonged ileus

PS:

Performance status

WBC:

White blood cell count

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Acknowledgments

The authors thank members of the Clinical Research Support Center in Asahi General Hospital for data acquisition and for providing helpful insights.

Author information

Author notes

  1. Kotaro Sugawara and Yoshikuni Kawaguchi contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba, Japan

    Kotaro Sugawara, Yoshikuni Kawaguchi, Yukihiro Nomura, Yusuke Suka, Keishi Kawasaki, Daisuke Koike, Motoki Nagai, Takatoshi Furuya & Nobutaka Tanaka

  2. Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan

    Kotaro Sugawara

  3. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yoshikuni Kawaguchi

  4. Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan

    Yukari Uemura

Authors
  1. Kotaro Sugawara
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  2. Yoshikuni Kawaguchi
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  3. Yukihiro Nomura
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  4. Yusuke Suka
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  7. Daisuke Koike
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  8. Motoki Nagai
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  9. Takatoshi Furuya
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  10. Nobutaka Tanaka
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Contributions

The conception or design of the work: Sugawara, Kawaguchi, Nomura, Tanaka.

The acquisition of data for the work: Sugawara, Suka, Kawasaki.

The analysis of data for the work: Sugawara, Kawaguchi, Uemura, Koike, Nagai, Furuya.

The interpretation of data for the work: Sugawara, Kawaguchi, Nomura, Tanaka.

Corresponding authors

Correspondence to Yoshikuni Kawaguchi or Nobutaka Tanaka.

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Type of Study

Retrospective.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Sugawara, K., Kawaguchi, Y., Nomura, Y. et al. Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery. J Gastrointest Surg 22, 508–515 (2018). https://doi.org/10.1007/s11605-017-3622-8

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  • DOI: https://doi.org/10.1007/s11605-017-3622-8

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