Abstract
Purpose
There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification.
Methods
A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons.
Results
A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations.
Conclusion
This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.
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Acknowledgements
The authors would like to acknowledge all the surgeons and anesthetists who participated in the global survey and were involved in the assessment of the reproducibility of the classification: Dr Mucci S, Dr Casa C, Dr Fuks D, Dr Hardwigsen J, Dr Gaujoux S, Pr Pocard M, Dr Levard H, Pr Sastre B, Pr Dousset B, Dr Mariani P, Pr Lehur P, Dr Rio D, Pr Fingerhut A, Dr Rault A, Dr Finel JB, Dr Branger F, Dr Le Naoures P, Dr Blanchard L, Pr Sabbagh C, Mr Jaouen R, Mrs Peneau C, Mr Colas PA, Mr Barbieux J, Mr Mougin J, Mr Le Fouler A, Dr Bouvier A, Dr Landreau P, Mr Gilbert A, Mr Borraccino B, Mr Gout M, Dr Santucci N, Mr Khaoudy I, Mr Gracient A, Mr Prevot F, Mr Chaibi S, Mr Mariage M, Dr Dhari A, and Mr Darmon I.
This list is unfortunately incomplete but a part of the survey was anonymous to avoid bias. The authors would also like to acknowledge the participants who did not give their name.
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Venara, A., Slim, K., Regimbeau, JM. et al. Proposal of a new classification of postoperative ileus based on its clinical impact—results of a global survey and preliminary evaluation in colorectal surgery. Int J Colorectal Dis 32, 797–803 (2017). https://doi.org/10.1007/s00384-017-2788-6
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DOI: https://doi.org/10.1007/s00384-017-2788-6