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