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Postoperative ileus concealing intra-abdominal complications in enhanced recovery programs—a retrospective analysis of the GRACE database

  • Aurélien Venara
  • Pascal Alfonsi
  • Eddy Cotte
  • Jérôme Loriau
  • Jean-François Hamel
  • Karem Slim
  • for the Francophone Group for Enhanced Recovery After Surgery (GRACE)
Original Article

Abstract

Purpose

Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery.

Methods

This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required.

Results

Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30–6.28), urinary retention (OR = 1.75; 95% CI: 1.05–2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04–9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15–8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74–8.88 and OR = 5.76; 95% CI: 3.56–10.62).

Conclusion

Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.

Keywords

Postoperative ileus Anastomotic leakage Morbidity Colorectal surgery 

Notes

Authors’ contribution

Aurélien Venara and Karem Slim made substantial contributions to the conception and design of this work, acquisition, and interpretation of data and drafted the manuscript. They gave their final approval of the version to be published and their agreement to be held accountable for all aspects of the work.

Pascal Alfonsi, Eddy Cotte, and Jérôme Loriau made substantial contributions to the acquisition and interpretation of data and critically revised the manuscript, as well as giving their final approval of the version to be published and their agreement to be held accountable for all aspects of the work.

Jean François Hamel made substantial contributions to the interpretation and analysis of data and drafted the manuscript, as well as giving his final approval of the version to be published and his agreement to be held accountable for all aspects of the work.

Funding

Web-hosting 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

384_2018_3165_MOESM1_ESM.docx (24 kb)
ESM 1 (DOCX 24.2 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Aurélien Venara
    • 1
    • 2
    • 3
    • 4
  • Pascal Alfonsi
    • 5
  • Eddy Cotte
    • 6
    • 7
  • Jérôme Loriau
    • 8
  • Jean-François Hamel
    • 3
    • 9
  • Karem Slim
    • 10
  • for the Francophone Group for Enhanced Recovery After Surgery (GRACE)
  1. 1.Department of Visceral SurgeryCHU of AngersAngers Cedex 9France
  2. 2.UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain DisordersInstitut des Maladies de l’Appareil DigestifNantesFrance
  3. 3.LUNAMUniversity of AngersAngersFrance
  4. 4.HIFIH Laboratory (UPRES 3859)University of Angers, ULBAngersFrance
  5. 5.Department of AnesthesiologyGroupe Hospitalier Paris Saint JosephParisFrance
  6. 6.Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-SudUniversité de LyonPierre-Bénite CedexFrance
  7. 7.Faculty of medicine Lyon-Sud/ Charles MérieuxOullins CedexFrance
  8. 8.Department of Visceral SurgeryGroupe Hospitalier Paris Saint JosephParisFrance
  9. 9.Department of Methodology and BiostatisticsCHU AngersAngers Cedex 9France
  10. 10.Department of Visceral SurgeryCHU Clermont-FerrandClermont FerrandFrance

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