Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery
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Prolonged postoperative ileus (PPOI) is among the common complications adversely affecting postoperative outcomes. Predictors of PPOI after major abdominal surgery remain unclear, although various PPOI predictors have been reported in patients undergoing colorectal surgery. This study aimed to devise a model for stratifying the probability of PPOI in patients undergoing abdominal surgery.
Between 2012 and 2013, 841 patients underwent major abdominal surgery after excluding patients who underwent less-invasive abdominal surgery, ileus-associated surgery, and emergency surgery. Postoperative managements were generally based on enhanced recovery after surgery (ERAS) program. The definition of PPOI was based on nausea, no oral diet, flatus absence, abdominal distension, and radiographic findings. A nomogram was devised by evaluating predictive factors for PPOI.
Of the 841 patients, 73 (8.8%) developed PPOI. Multivariable logistic regression analysis revealed smoking history (P = 0.025), colorectal surgery (P = 0.004), and an open surgical approach (P = 0.002) to all be independent predictive factors for PPOI. A nomogram was devised by employing these three significant predictive factors. The prediction model showed relatively good discrimination performance, the concordance index of which was 0.71 (95%CI 0.66–0.77). The probability of PPOI in patients with a smoking history who underwent open colorectal surgery was calculated to be 19.6%.
Colorectal surgery, open abdominal surgery, and smoking history were found to be independent predictive factors for PPOI in patients who underwent major abdominal surgery. A nomogram based on these factors was shown to be useful for identifying patients with a high probability of developing PPOI.
KeywordsPostoperative prolonged ileus Nomogram Colorectal surgery Upper gastrointestinal surgery Laparoscopic surgery
American Society of Anesthesiologists Physical Status classification system
Body mass index
Chronic obstructive pulmonary disease
Estimated blood loss
Estimated glomerular filtration rate
Enhanced recovery after surgery
Prognostic nutritional index
Postoperative prolonged ileus
White blood cell count
The authors thank members of the Clinical Research Support Center in Asahi General Hospital for data acquisition and for providing helpful insights.
The conception or design of the work: Sugawara, Kawaguchi, Nomura, Tanaka.
The acquisition of data for the work: Sugawara, Suka, Kawasaki.
The analysis of data for the work: Sugawara, Kawaguchi, Uemura, Koike, Nagai, Furuya.
The interpretation of data for the work: Sugawara, Kawaguchi, Nomura, Tanaka.
Compliance with Ethical Standards
Type of Study
Conflict of Interest
The authors declare that they have no conflicts of interest.
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