Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study
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Enhanced recovery after surgery (ERAS) protocols advocate no nasogastric tubes after colorectal surgery, but postoperative ileus (POI) remains a challenging clinical reality. The aim of this study was to assess incidence and risk factors of POI.
This retrospective analysis included all consecutive colorectal surgical procedures since May 2011 until November 2014. Uni- and multivariate risk factors for POI were identified by multiple logistic regression and functional and surgical outcomes assessed.
The study cohort consisted of 513 consecutive colorectal ERAS patients. One hundred twenty-eight patients (24.7%) needed postoperative reinsertion of nasogastric tube at the 3.9 ± 2.9 postoperative day. Multivariate analysis retained the American Society of Anesthesiologists group 3–4 (odds ratio (OR) 1.3; 95% CI 1–1.8, p = 0.043) and duration of surgery of >3 h (OR 1.3; 95% CI 1–1.7, p = 0.047) as independent risk factors for POI. Minimally invasive surgery (OR 0.6; 95% CI 0.5–0.8, p ≤ 0.001) and overall compliance of >70% to the ERAS protocol (OR 0.7; 95% CI 0.6–1, p = 0.031) represented independent protective factors. POI was associated with respiratory (23 vs. 5%, p ≤ 0.001) and cardiovascular (16 vs. 3%, p ≤ 0.001) complications.
POI was frequent in the present study. Overall compliance to the ERAS protocol and minimally invasive surgery helped to prevent POI, which was significantly correlated with medical complications.
KeywordsEnhanced recovery Fast track Colorectal Ileus Nasogastric drainage Compliance
The authors would like to acknowledge the support provided by all members of the enhanced recovery team in Lausanne, and especially the dedicated nurse V. Addor.
Statement of authorship
Fabian Grass: design, analysis and interpretation, drafting
Juliette Slieker: design, analysis and interpretation, critical revision
Jonas Jurt: analysis and interpretation, critical revision
Anne Kummer: interpretation, critical revision
Dieter Hahnloser: analysis and interpretation, critical revision
Nicolas Demartines: conception, interpretation, critical revision
Martin Hübner: conception and design, analysis and interpretation, drafting
All authors approved the final version
Compliance with ethical standards
This study was approved by the Institutional Review Board (Commission cantonale d’éthique de la recherche sur l’être humain (CER-VD)), and informed consent was obtained from every patient.
Conflict of interest
The authors declare that they have no conflict of interest.
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