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Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis

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A Correction to this article was published on 28 January 2020

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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.

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Change history

  • 28 January 2020

    In the list of participating investigators that appears in Acknowledgements, one of the investigators names appears incorrectly.

References

  1. Venara A, Slim K, Regimbeau J-M et al (2017) Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery. Int J Colorectal Dis 32:797–803

    Article  Google Scholar 

  2. Asgeirsson T, El-Badawi KI, Mahmood A, Barletta J, Luchtefeld SA (2010) Postoperative ileus: it costs more than you expect. J Am Coll Surg 210:228–231

    Article  Google Scholar 

  3. Barbieux J, Hamy A, Talbot MF et al (2017) Does enhanced recovery reduce postoperative ileus after colorectal surgery? J Visc Surg 154:79–85

    Article  CAS  Google Scholar 

  4. Grass F, Slieker J, Jurt J, Kummer A et al (2017) Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study. Int J Colorectal Dis 32:675–681

    Article  Google Scholar 

  5. Gignoux B, Gosgnach M, Lanz T et al (2018) Short-term outcomes of ambulatory colectomy for 157 consecutive patients. Ann Surg (in press)

  6. Venara A, Alfonsi P, Cotte E, Loria J, Hamel JF, Slim K, Francophone Group for enhanced recovery after surgery (2018) Postoperative ileus concealing intra-abdominal complications in enhanced recovery programs-a retrospective analysis of the GRACE database. Int J Colorectal Dis 34:71–83

    Article  Google Scholar 

  7. Courtot L, Le Roy B, Memeo R et al (2018) Risk factors for postoperative ileus following elective laparoscopic right colectomy: a retrospective multicentric study. Int J Colorectal Dis 33:1373–1382

    Article  Google Scholar 

  8. Yorkshire Surgical Research Collaborative (2018) Multicentre observational study of gastrointestinal recovery after elective colorectal surgery. Colorectal Dis 20:536–544

    Article  Google Scholar 

  9. Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972

    Article  Google Scholar 

  10. Wolthuis AM, Bislenghi G, Fieuws S et al (2016) Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 18:O1–O9

    Article  CAS  Google Scholar 

  11. Vather R, Josephson R, Jaung R, Robertson J, Bissett I (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157:764–773

    Article  Google Scholar 

  12. Ceretti AP, Maroni N, Longhi M et al (2018) Risk factors for prolonged postoperative Ileus in adult patients undergoing elective colorectal surgery: an observational cohort study. Rev Recent Clin Trials 13:295–304

    Article  Google Scholar 

  13. Wolthuis AM, Bislenghi G, Lambrecht M et al (2017) Preoperative risk factors for prolonged postoperative ileus after colorectal resection. Int J Colorectal Dis 32:883–890

    Article  Google Scholar 

  14. Mariette C, Alves A, Benoist S, Bretagnol F, Mabrut JY, Slim K (2015) Perioperative care in digestive surgery. Guidelines for the French society of digestive surgery (SFCD). Ann Chir 130:108–124

    Article  Google Scholar 

  15. Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, Meurette G (2016) Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg 153:439–446

    Article  CAS  Google Scholar 

  16. Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E (2012) Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg 36:179–185. https://doi.org/10.1007/s00268-011-1339-5

    Article  PubMed  Google Scholar 

  17. Rybakov EG, Shelygin YA, Khomyakov EA, Zarodniuk IV (2017) Risk factors for postoperative ileus after colorectal cancer surgery. Colorectal Dis (in press)

  18. Kalff JC, Schraut WH, Simmons RL, Bauer AJ (1998) Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 228:652–663

    Article  CAS  Google Scholar 

  19. Uemura K, Tatewaki M, Harris MB et al (2004) Magnitude of abdominal incision affects the duration of postoperative ileus in rats. Surg Endosc 18:606–610

    Article  CAS  Google Scholar 

  20. Gervaz P, Inan I, Perneger T, Schiffer E, Morel P (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252:3–8

    Article  Google Scholar 

  21. The FO, Bennink RJ, Ankum WM et al (2008) Intestinal handling-induced mast cell activation and inflammation in human postoperative ileus. Gut 57:33–40

    Article  CAS  Google Scholar 

  22. Cali RL, Meade PG, Swanson MS, Freeman C (2000) Effect of Morphine and incision length on bowel function after colectomy. Dis Colon Rectum 43:163–168

    Article  CAS  Google Scholar 

  23. Kaufman PN, Krevsky B, Malmud LS, Maurer AH, Chase BJ, Fisher RS (1998) Role of opiate receptors in the regulation of colonic transit. Gastroenterology 94:1351–1356

    Article  Google Scholar 

  24. Chen JY, Ko TL, Wen YR, Wu SC, Chou YH, Yien HW, Kuo CD (2009) Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain 25:485–489

    Article  CAS  Google Scholar 

  25. Elsamra SE, Ellsworth P (2012) Effects of analgesic and anesthetic medications on lower urinary tract function. Urol Nurs 32:60–67

    Article  Google Scholar 

  26. Grass F, Slieker J, Frauche P et al (2017) Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway. J Surg Res 207:70–76

    Article  Google Scholar 

  27. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19:667–674

    Article  CAS  Google Scholar 

  28. Zhuang CL, Chen FF, Lu JX et al (2015) Impact of different surgical traumas on postoperative ileus in rats and the mechanism involved. Int J Clin Exp Med 15:16778–16786

    Google Scholar 

Download references

Acknowledgements

GRACE Collaborative Group for Ileus Study/Participating Investigators who provided care for study patients: CHAPUIS O, GUIGNARD B (Clinique du Val d’Or, Saint Cloud, France), GERMAIN A (Nancy, France), SAINT DENIS M, SIRIEIX D (Hôpital privé d’Antony, Antony, France), ARIMONT JM, FIGUET S (CH-Alpes Leman, Contamine sur Arve, France), MILOU F (HIA Desgenettes, Lyon, France), HAIL K (Clinique Chirurgicale B, CHU Mustapha, Alger, Algérie), K OTHONIDIS K (App Sambre et Meuse/CHR Val de Sambre, Sambreville, France), FAUCHERON JL, SAGE PY (CHU Grenoble Alpes, La Tronche, France), MAUVAIS F (CH Beauvais, Beauvais, France), RIO D (CH Bretagne Atlantique, Vannes, France), GUIOT JL (Pole Santé du Plateau, Meudon La Forêt, France), POINCENOT J (CHIC, Créteil, France), CUELLAR E (CHU Toulouse, Toulouse, France), LUYER M, BOUDEWIJN S (Catharina Hospital, Eindhoven, The Netherlands), AUMONT O, DUPRE A, POIBLANC M, SENS N (Centre Leon Berard, Lyon, France), BRIGAND C, STEINMETZ JP (Hôpital de Hautepierre, Strasbourg, France), PLUMEREAU F (CH Laval, France), MATHONNET M, CHRISTOU N (CHRU Limoges, Limoges, France), ORTEGA-DEBALLON P, VAUCLAIR E (CHU Dijon, Dijon, France), BOZIO G (Médipole de Savoie, Challes Les Eaux, France), FERNOUX P, MASSARD JL (Hôpital Privé Sainte Marie, Chalon sur Saone, France), BELLOUARD A, de la FONTAINE C, FINIANOS A, MICHAUD P (Clinique de l’Archette, Olivet, France), BOSSARD AE, DENET C, GRIGORIU M, KATTOU F (Institut Mutualiste Montsouris, Paris, France), GIGNOUX B, VERRIER JF (Clinique de la Sauvegarde, Lyon, France), RASPADO O (Infirmerie protestante, Caluire et Cuire, France), ARNALSTEEN L, LAMBLIN A (Hôpital Privé La Louvière, Lille, France), DOLBEAU JB (Polyclinique Bordeaux Rive Droite, Lormon, France), AUVRAY S, LAMMENS S, LEPORRIER J, SIRISIER F (Hôpital privé Saint Martin, Caen, France), DILEON S (Clinique Saint Roch, Cavaillon, France).

Funding

Webhosting of GRACE-audit data was funded by the “Caisse National D’Assurance Maladie.”

Author information

Authors and Affiliations

  1. Faculty of Medicine of Angers, Angers, France

    A. Venara

  2. Department of Visceral and Endocrinal Surgery (Service de chirurgie viscérale et endocrinienne), CHU Angers, 4, Rue Larrey, 49933, Angers Cedex 9, France

    A. Venara

  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

    A. Venara & E. Duchalais

  4. Institut Paoli-Calmette, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France

    H. Meillat

  5. Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite Cedex, France

    E. Cotte

  6. Université de Lyon, Lyon, France

    E. Cotte

  7. Department of Visceral Surgery, CHU Tours, 2 Boulevard Tonnelé, 37000, Tours, France

    M. Ouaissi

  8. Department of Visceral Surgery, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France

    E. Duchalais

  9. Department of Visceral Surgery, Clinique de l’Alliance, 1 Boulevard A Nobel, 37540, Saint Cyr Sur Loire, France

    C. Mor-Martinez

  10. Department of Abdominal Surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    A. Wolthuis

  11. Department of Visceral Surgery, CHU Amiens, Avenue Laennec, 80054, Amiens, France

    J. M. Regimbeau

  12. Hirslanden Clinique La Colline, Geneva, Switzerland

    S. Ostermann

  13. Department of Methodology and Biostatistics, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France

    J. F. Hamel

  14. Department of Anesthesiology, CHU Liège, Domaine de Sart Tilman, Université de Liège, 4000, Liege, Belgium

    J. Joris

  15. Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont-Ferrand, France

    K. Slim

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  1. A. Venara
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  2. H. Meillat
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  7. A. Wolthuis
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Consortia

the GRACE Collaborative Group For Ileus Study

  • O Chapuis
  • , B Guignard
  • , M Saint Denis
  • , D Sirieix
  • , JM Arimont
  • , S Figuet
  • , F Milou
  • , K Hail
  • , K Kothonidis
  • , JL Faucheron
  • , PY Sage
  • , F Mauvais
  • , D Rio
  • , JL Guiot
  • , J Poincenot
  • , E Cuellar
  • , M Luyer
  • , S Boudewijn
  • , O Aumont
  • , A Dupre
  • , M Poiblanc
  • , N Sens
  • , C Brigand
  • , JP Steinmetz
  • , F Plumereau
  • , M Mathonnet
  • , N Christou
  • , P Ortega-Deballon
  • , E Vauclair
  • , G Bozio
  • , P Fernoux
  • , JL Massard
  • , A Bellouard
  • , C de la Fontaine
  • , A Finianos
  • , P Michaud
  • , AE Bossard
  • , C Denet
  • , M Grigoriu
  • , F Kattou
  • , B Gignoux
  • , JF Verrier
  • , O Raspado
  • , L Arnalsteen
  • , A Lamblin
  • , JB Dolbeau
  • , S Auvray
  • , S Lammens
  • , J Leporrier
  • , F Sirisier
  •  & S Dileon

Contributions

AV contributed to conception, design, analysis and interpretation of data; manuscript author provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published. HM, EC, MO, ED, CMM, AW, JMR, SO, JJ have provided care for study patients, provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published. JFH contributed to methodology, statistical analysis and interpretation. Final approval of the version to be published. KS contributed to conception, design, analysis and interpretation of data, provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published.

Corresponding author

Correspondence to A. Venara.

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Venara, A., Meillat, H., Cotte, E. et al. Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis. World J Surg 44, 957–966 (2020). https://doi.org/10.1007/s00268-019-05278-3

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