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Selective Opioid Antagonists Following Bowel Resection for Prevention of Postoperative Ileus: a Systematic Review and Meta-analysis

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Postoperative ileus (POI) remains a common complication following bowel resection. Selective opioid antagonists have been increasingly studied as prophylactic pharmaceutical aids to reduce rates of POI. The aim of this study was to evaluate the impact of selective opioid antagonists on return of bowel function following bowel resection.

Methods

MEDLINE, Embase, and CENTRAL were systematically searched. Articles were included if they compared the incidence of POI and/or length of stay (LOS) in patients receiving and not receiving selective opioid antagonists following elective bowel resection. A pairwise meta-analyses using inverse variance random effects was performed.

Results

From 636 citations, 30 studies with 45,051 patients receiving selective opioid antagonists (51.3% female, mean age: 60.9) and 55,071 patients not receiving selective opioid antagonists (51.2% female, mean age: 61.1) were included. Patients receiving selective opioid antagonists had a significantly lower rate of POI (10.1% vs. 13.8%, RR 0.68, 95%CI 0.63–0.75, p < 0.01). Selective opioid antagonists also significantly reduced LOS (MD − 1.08, 95%CI − 1.47 to − 0.69, p < 0.01), readmission (RR 0.94, 95%CI 0.89–0.99, p = 0.03), and 30-day morbidity (RR 0.85, 95%CI 0.79–0.90, p < 0.01). Improvements in LOS, readmission rate, and morbidity were not significant when analysis was limited to laparoscopic surgery. There was no significant difference in inpatient healthcare costs (SMD − 0.33, 95%CI − 0.71–0.04, p = 0.08).

Conclusions

Rate of POI decreases with the use of selective opioid antagonists in patients undergoing bowel resection. Selective opioid antagonists also improve LOS, rates of readmission, and 30-day morbidity for patients undergoing open bowel resection. Addition of these medications to enhance recovery after surgery protocols should be considered.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Tyler McKechnie, Yung Lee & Cagla Eskicioglu

  2. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Tharani Anpalagan, Simarpreet Ichhpuniani & Cagla Eskicioglu

  3. Division of General Surgery, Department of Surgery, St. Joseph Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, Ontario, L8N 4A6, Canada

    Karim Ramji & Cagla Eskicioglu

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  1. Tyler McKechnie
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Conception and design of the study—all authors

Acquisition of data—McKechnie, Anpalagan, Ichhpuniani

Analysis and interpretation of data—all authors

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Correspondence to Cagla Eskicioglu.

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Supplementary Information

Supplemental Figure 1

Funnel Plot for Overall Postoperative Ileus Random Effect Meta-Analysis (PNG 46215 kb)

High resolution image (TIFF 64 kb)

Supplemental Figure 2

Cochrane Risk of Bias Tool for Randomized Controlled Trials 2.0 individual study analyses (PNG 31358 kb)

High resolution image (TIFF 228 kb)

Supplemental Figure 3

Cochrane Risk of Bias Tool for Randomized Controlled Trials 2.0 grouped outcomes for included RCTs (PNG 34939 kb)

High resolution image (TIFF 83 kb)

Supplemental Figure 4

Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) assessment tool results per individual observational study (PNG 72883 kb)

High resolution image (TIFF 704 kb)

Supplemental Figure 5

Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) assessment tool pooled risk of bias for included observational studies (PNG 8313 kb)

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Appendix 1

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Table 4 Complete search strategy (Medline database example)
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McKechnie, T., Anpalagan, T., Ichhpuniani, S. et al. Selective Opioid Antagonists Following Bowel Resection for Prevention of Postoperative Ileus: a Systematic Review and Meta-analysis. J Gastrointest Surg 25, 1601–1624 (2021). https://doi.org/10.1007/s11605-021-04973-8

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