Risk factors for prolonged ileus following colon surgery
Prolonged ileus is one of the most common postoperative complications after colorectal surgery. We sought to investigate the predictors of prolonged ileus following elective colon resections procedures.
The national participant user files of NSQIP databases were utilized to examine the clinical outcomes of patients undergoing elective colon resection during 2012–2013. Multivariate regression analysis was performed to investigate predictors of prolonged ileus. Prolonged ileus was defined as no return of bowel function in 7 days.
We sampled a total of 27,560 patients who underwent colon resections; of these, 3497 (12.7 %) patients had prolonged ileus. Patients with ileocolonic anastomosis (ICA) had a significantly higher rate of prolonged ileus compared to patients with colorectal anastomosis (CRA) (15 vs. 11.5 %, AOR 1.25, P < 0.01). Prolonged ileus was significantly associated with intra-abdominal infections (13 vs. 2.8 %, AOR 2.56, P < 0.01) and anastomotic leakage (12 vs. 2.4 %, AOR 2.50, P < 0.01). Factors such as preoperative sepsis (AOR 1.63, P < 0.01), disseminated cancer (AOR 1.24, P = 0.01), and chronic obstructive pulmonary disease (AOR 1.27, P = 0.02) were associated with an increased risk of prolonged ileus, whereas oral antibiotic bowel preparation (AOR 0.77, P < 0.01) and laparoscopic surgery (AOR 0.51, P < 0.01) are associated with decreased prolonged ileus risk.
Prolonged ileus is a common condition following colon resection, with an incidence of 12.7 %. Among colon surgeries, colectomy with ICA resulted in the highest rate of postoperative prolonged ileus. Prolonged ileus is positively associated with anastomotic leak and intra-abdominal infections; thus, a high index of suspicion must be had in all patients with prolonged postoperative ileus.
KeywordsProlonged ileus Colorectal surgery Paralytic ileus
Dr. Stamos has received educational grants and speaker fees paid to the Department of Surgery, University of California, Irvine, from Ethicon, Gore, Covidien, and Olympus. Dr. Mills and Dr. Carmichael received Ethicon educational grants paid to the Department of Surgery, University of California, Irvine. Dr. Pigazzi is a consultant for Intuitive Surgical and has also received consultancy fees and educational grants paid to the Department of Surgery, University of California, Irvine. Dr. Moghadamyeghaneh, Dr. Phelan, Dr. Hwang, and Dr. Hanna have no disclosures. Dr. Moghadamyeghaneh had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
- 4.Delaney C, Kehlet H, Senagore AJ, Bauer AJ, Beart R, Billingham R et al (2006) (eds) Clinical consensus update in general surgery [Internet] Roswell: pharmatecture, LLC; [cited 2015 Feb 1]. http://www.clinicalwebcasts.com/pdfs/GenSurg_WEB.pdf
- 13.National Surgical Quality Improvement Program (2005) [home page on the Internet] Chicago, IL: American College of Surgeons. [cited 2015 Jan 17]. www.acsnsqip.org