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

  • A. VenaraEmail author
  • 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
  • the GRACE Collaborative Group For Ileus Study
Original Scientific Report
  • 59 Downloads

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.

Notes

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).

Authors’ contribution

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.

Funding

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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

268_2019_5278_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)
268_2019_5278_MOESM2_ESM.docx (24 kb)
Supplementary material 2 (DOCX 24 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • A. Venara
    • 1
    • 2
    • 3
    Email author
  • H. Meillat
    • 4
  • E. Cotte
    • 5
    • 6
  • M. Ouaissi
    • 7
  • E. Duchalais
    • 3
    • 8
  • C. Mor-Martinez
    • 9
  • A. Wolthuis
    • 10
  • J. M. Regimbeau
    • 11
  • S. Ostermann
    • 12
  • J. F. Hamel
    • 13
  • J. Joris
    • 14
  • K. Slim
    • 15
  • the GRACE Collaborative Group For Ileus Study
  1. 1.Faculty of Medicine of AngersAngersFrance
  2. 2.Department of Visceral and Endocrinal Surgery (Service de chirurgie viscérale et endocrinienne)CHU AngersAngers Cedex 9France
  3. 3.UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain DisordersInstitut des Maladies de l’Appareil DigestifNantesFrance
  4. 4.Institut Paoli-CalmetteMarseilleFrance
  5. 5.Department of Visceral SurgeryCHU Lyon, Centre Hospitalier Lyon-SudPierre-Bénite CedexFrance
  6. 6.Université de LyonLyonFrance
  7. 7.Department of Visceral SurgeryCHU ToursToursFrance
  8. 8.Department of Visceral SurgeryCHU NantesNantesFrance
  9. 9.Department of Visceral SurgeryClinique de l’AllianceSaint Cyr Sur LoireFrance
  10. 10.Department of Abdominal SurgeryUZ LeuvenLeuvenBelgium
  11. 11.Department of Visceral SurgeryCHU AmiensAmiensFrance
  12. 12.Hirslanden Clinique La CollineGenevaSwitzerland
  13. 13.Department of Methodology and BiostatisticsCHU AngersAngers Cedex 9France
  14. 14.Department of Anesthesiology, CHU Liège, Domaine de Sart TilmanUniversité de LiègeLiegeBelgium
  15. 15.Department of Visceral SurgeryCHU Clermont-FerrandClermont-FerrandFrance

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