Journal of Gastrointestinal Surgery

, Volume 22, Issue 3, pp 508–515 | Cite as

Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery

  • Kotaro Sugawara
  • Yoshikuni Kawaguchi
  • Yukihiro Nomura
  • Yusuke Suka
  • Keishi Kawasaki
  • Yukari Uemura
  • Daisuke Koike
  • Motoki Nagai
  • Takatoshi Furuya
  • Nobutaka Tanaka
Original Article



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.


Postoperative 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


Interquartile range


Prognostic nutritional index


Postoperative day


Postoperative prolonged ileus


Performance status


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.

Authors’ Contributions

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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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  1. 1.Department of SurgeryAsahi General HospitalAsahiJapan
  2. 2.Department of Gastrointestinal SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
  3. 3.Hepato-Biliary-Pancreatic Surgery Division, Department of SurgeryGraduate School of Medicine, University of TokyoTokyoJapan
  4. 4.Biostatistics DivisionClinical Research Support Center, Graduate School of Medicine, the University of TokyoTokyoJapan

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