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What are the risk factors of failure of enhanced recovery after right colectomy? Results of a prospective study on 140 consecutive cases

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Nausea and vomiting is the main cause of failure of enhanced recovery protocol (ERP) after right hemicolectomy.

Methods

From January 2013 to January 2018, all patients undergoing right hemicolectomy were prospectively included. Patients undergoing emergency surgery, additional complex procedure or temporary stoma, nasogastric tube (NGT) maintenance, or abdominal drainage were excluded. Failure of ERP was defined as nausea/vomiting precluding oral feeding after POD3 and/or the occurrence of postoperative ileus requiring NGT and/or length of stay (LOS) ≥ 8 days except for patients awaiting admission in rehabilitation unit. Risk factors of failure of ERP were identified using univariate and multivariate analysis.

Results

Among 306 patients undergoing right hemicolectomy, 140 fulfilled the inclusion criteria. Postoperative morbidity was 31%, and the mortality rate was nil. The mean postoperative hospital stay was 7 days (range 2–30). Successful ERP was achieved in 83 patients (59%). Causes of failure were major nausea/vomiting precluding oral feeding after POD3 in 36, postoperative ileus requiring NGT in 16 and LOS ≥ 8 days in 36. On multivariate analysis, preoperative anemia (OR 5.2; CI 95%, 1.3–21.1, p = 0.02) and platelet anti-aggregant/anti-coagulant (OR 4.5; CI 95%, 1.7–12.1, p = 0.003) were associated with the risk of failure of ERP.

Conclusion

This study shows that anemia and medication with antiplatelet/anticoagulation therapy increase the risk of failure of ERP after right hemicolectomy that translates most of the time by nausea/vomiting and postoperative ileus. The presence of these factors should lead to adapt the strategy to improve outcome rather than be considered as contraindication to ERP.

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References

  1. Eskicioglu C, Forbes SS, Aarts M-A et al (2009) Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg Off J Soc Surg Aliment Tract 13:2321–2329. https://doi.org/10.1007/s11605-009-0927-2

    Article  Google Scholar 

  2. Wind J, Polle SW, Fung Kon Jin PHP, Dejong CH, von Meyenfeldt M, Ubbink DT, Gouma DJ, Bemelman WA, Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group, Enhanced Recovery after Surgery (ERAS) Group (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809. https://doi.org/10.1002/bjs.5384

    Article  CAS  Google Scholar 

  3. Gustafsson UO, Scott MJ, Hubner M et al (2018) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg. https://doi.org/10.1007/s00268-018-4844-y

  4. Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, Sultan S, Wilt TJ (2018) Enhanced recovery protocols for adults undergoing colorectal surgery: a systematic review and meta-analysis. Dis Colon Rectum 61:1108–1118. https://doi.org/10.1097/DCR.0000000000001160

    Article  Google Scholar 

  5. Maggiori L, Rullier E, Lefevre JH et al (2017) Does a combination of laparoscopic approach and full fast track multimodal management decrease postoperative morbidity?: a multicenter randomized controlled trial. Ann Surg 266:729. https://doi.org/10.1097/SLA.0000000000002394

    Article  Google Scholar 

  6. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld B, van der Zaag E, van Geloven A, Sprangers MA, Cuesta MA, Bemelman WA, LAFA study group (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875. https://doi.org/10.1097/SLA.0b013e31821fd1ce

    Article  Google Scholar 

  7. Barbieux J, Hamy A, Talbot MF, Casa C, Mucci S, Lermite E, Venara A (2017) Does enhanced recovery reduce postoperative ileus after colorectal surgery? J Visc Surg 154:79–85. https://doi.org/10.1016/j.jviscsurg.2016.08.003

    Article  CAS  Google Scholar 

  8. Grass F, Slieker J, Jurt J, Kummer A, Solà J, Hahnloser D, Demartines N, Hübner M (2017) Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study. Int J Color Dis 32:675–681. https://doi.org/10.1007/s00384-017-2789-5

    Article  Google Scholar 

  9. Venara A, Alfonsi P, Cotte E, Loriau J, Hamel JF, Slim K, Francophone Group for Enhanced Recovery After Surgery (GRACE) (2019) Postoperative ileus concealing intra-abdominal complications in enhanced recovery programs-a retrospective analysis of the GRACE database. Int J Color Dis 34:71–83. https://doi.org/10.1007/s00384-018-3165-9

    Article  Google Scholar 

  10. Moghadamyeghaneh Z, Hwang GS, Hanna MH, Phelan M, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609. https://doi.org/10.1007/s00464-015-4247-1

    Article  Google Scholar 

  11. Studer P, Räber G, Ott D et al (2016) Risk factors for fatal outcome in surgical patients with postoperative aspiration pneumonia. Int J Surg Lond Engl 27:21–25. https://doi.org/10.1016/j.ijsu.2016.01.043

    Article  Google Scholar 

  12. Kummer A, Slieker J, Grass F, Hahnloser D, Demartines N, Hübner M (2016) Enhanced recovery pathway for right and left colectomy: comparison of functional recovery. World J Surg 40:2519–2527. https://doi.org/10.1007/s00268-016-3563-5

    Article  Google Scholar 

  13. Grass F, Lovely JK, Crippa J et al (2018) Comparison of recovery and outcome after left and right colectomy. Color Dis. https://doi.org/10.1111/codi.14543

  14. (2004) A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer. N Engl J Med 350:2050–2059. https://doi.org/10.1056/NEJMoa032651

  15. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726. https://doi.org/10.1016/S0140-6736(05)66545-2

    Article  Google Scholar 

  16. (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484. https://doi.org/10.1016/S1470-2045(05)70221-7

  17. Hübner M, Larson DW, Wolff BG (2012) “How I do it”--radical right colectomy with side-to-side stapled ileo-colonic anastomosis. J Gastrointest Surg 16:1605–1609. https://doi.org/10.1007/s11605-012-1909-3

    Article  Google Scholar 

  18. Petrowsky H, Demartines N, Rousson V, Clavien P-A (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240:1074–1084 discussion 1084-1085

    Article  Google Scholar 

  19. Karliczek A, Jesus EC, Matos D et al (2006) Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Color Dis 8:259–265. https://doi.org/10.1111/j.1463-1318.2006.00999.x

    Article  CAS  Google Scholar 

  20. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  Google Scholar 

  21. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007635.pub2

  22. Yuan L, O’Grady G, Milne T et al (2018) Prospective comparison of return of bowel function after left versus right colectomy: return of bowel function post colectomy. ANZ J Surg 88:E242–E247. https://doi.org/10.1111/ans.13823

    Article  Google Scholar 

  23. Zhuang C-L, Ye X-Z, Zhang C-J, Dong QT, Chen BC, Yu Z (2013) Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: a meta-analysis of randomized clinical trials. Dig Surg 30:225–232. https://doi.org/10.1159/000353136

    Article  Google Scholar 

  24. Garfinkle R, Al-Rashid F, Morin N et al (2019) Are right-sided colectomies for neoplastic disease at increased risk of primary postoperative ileus compared to left-sided colectomies? A coarsened exact matched analysis. Surg Endosc:1–8. https://doi.org/10.1007/s00464-019-07318-4

  25. Fineberg SJ, Nandyala SV, Kurd MF et al (2014) Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J 14:1680–1685. https://doi.org/10.1016/j.spinee.2013.10.015

    Article  Google Scholar 

  26. Artinyan A, Nunoo-Mensah JW, Balasubramaniam S et al (2008) Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World J Surg 32:1495–1500. https://doi.org/10.1007/s00268-008-9491-2

    Article  Google Scholar 

  27. Smilowitz NR, Oberweis BS, Nukala S et al (2016) Association between Anemia, bleeding, and transfusion with long-term mortality following noncardiac surgery. Am J Med 129:315–323.e2. https://doi.org/10.1016/j.amjmed.2015.10.012

    Article  Google Scholar 

  28. Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM (2016) The important role for intravenous Iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg 264:41–46. https://doi.org/10.1097/SLA.0000000000001646

    Article  Google Scholar 

  29. Keeler BD, Simpson JA, Fox SC et al (2015) An observational study investigating the effect of platelet function on outcome after colorectal surgery. Int J Surg Lond Engl 17:28–33. https://doi.org/10.1016/j.ijsu.2015.02.023

    Article  Google Scholar 

  30. Kariv Y, Wang W, Senagore AJ, Hammel JP, Fazio VW, Delaney CP (2006) Multivariable analysis of factors associated with hospital readmission after intestinal surgery. Am J Surg 191:364–371. https://doi.org/10.1016/j.amjsurg.2005.10.038

    Article  Google Scholar 

  31. Fang X, Baillargeon JG, Jupiter DC (2016) Continued antiplatelet therapy and risk of bleeding in gastrointestinal procedures: a systematic review. J Am Coll Surg 222:890-905.e11. https://doi.org/10.1016/j.jamcollsurg.2016.01.053

  32. Prevost GA, Odermatt M, Furrer M, Villiger P (2018) Postoperative morbidity of complete mesocolic excision and central vascular ligation in right colectomy: a retrospective comparative cohort study. World J Surg Oncol 16:214. https://doi.org/10.1186/s12957-018-1514-3

    Article  Google Scholar 

  33. Kisialeuski M, Pędziwiatr M, Matłok M, Major P, Migaczewski M, Kołodziej D, Zub-Pokrowiecka A, Pisarska M, Budzyński P, Budzyński A (2015) Enhanced recovery after colorectal surgery in elderly patients. Videosurgery Miniinvasive Tech 1:30–36. https://doi.org/10.5114/wiitm.2015.48697

    Article  Google Scholar 

  34. Benoit O, Faron M, Margot N, Creavin B, Debove C, Tiret E, Parc Y, Lefevre JH (2019) C-reactive protein values after colorectal resection: can we discharge a patient with a C-reactive protein value >100? A retrospective cohort study. Dis Colon Rectum 62:88–96. https://doi.org/10.1097/DCR.0000000000001216

    Article  Google Scholar 

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Acknowledgments

The authors particularly thank Sophie Bernier (Health manager) and Odile Blaess (Nurse practitioner) for their participation in design and the monitoring of the protocol.

Funding

This study was supported by the PREDI association (association pour la recherche en chirurgie digestive).

Author information

Authors and Affiliations

  1. Department of Oncologic and Digestive Surgery of Hôpital Bicêtre, Université Paris Sud, 63, rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France

    Clement Destan, Antoine Brouquet, Anne De Carbonnières, Pietro Genova, Bruno Costaglioli, Benoit Lambert, Christophe Penna & Stéphane Benoist

  2. Department of Anesthesiology of Hôpital Bicêtre, Assistance publique – Hôpitaux de Paris, Université Paris Sud, 63, rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France

    Christine Fessenmeyer & Jacques De Montblanc

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  1. Clement Destan
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Correspondence to Antoine Brouquet.

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The authors declare that they have no conflict of interest.

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This observational nontherapeutic study is a retrospective analysis of prospectively collected data and was conducted according to French ethics law.

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Destan, C., Brouquet, A., De Carbonnières, A. et al. What are the risk factors of failure of enhanced recovery after right colectomy? Results of a prospective study on 140 consecutive cases. Int J Colorectal Dis 35, 1291–1299 (2020). https://doi.org/10.1007/s00384-020-03590-2

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