Surgical Endoscopy

, Volume 33, Issue 7, pp 2313–2322 | Cite as

Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway

  • Mohsen Alhashemi
  • Julio F. FioreJr.
  • Nadia Safa
  • Mohammed Al Mahroos
  • Juan Mata
  • Nicolò Pecorelli
  • Gabriele Baldini
  • Nandini Dendukuri
  • Barry L. Stein
  • A. Sender Liberman
  • Patrick Charlebois
  • Franco Carli
  • Liane S. FeldmanEmail author
2018 SAGES Oral



Prolonged postoperative ileus (PPOI) is common after colorectal surgery but has not been widely studied in the context of enhanced recovery pathways (ERPs) that include interventions aimed to accelerate gastrointestinal recovery. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery.


We analyzed data from an institutional colorectal surgery ERP registry. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and absence of flatus or bowel movement for ≥ 4 days) and compared to other definitions in the literature. Potential risk factors for PPOI were identified from previous studies, and their predictive ability was evaluated using Bayesian model averaging (BMA). Results are presented as posterior effect probability (PEP). Evidence of association was categorized as: no evidence (PEP < 50%), weak evidence (50–75%), positive evidence (75–95%), strong evidence (95–99%), and very strong evidence (> 99%).


There were 323 patients analyzed (mean age 63.5 years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11 and 59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48 h (PEP 94%; strong evidence), postoperative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3 ml/kg/h for laparoscopic and 5 ml/kg/h for open; PEP 55%, weak evidence) were predictors of PPOI.


The incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably by diagnostic criteria, highlighting the need for a consensus definition. The use of intravenous opioids is a modifiable strong predictor of PPOI within an ERP, while the role of epidural analgesia and intraoperative fluid management should be further evaluated.


Colorectal Surgery Postoperative ileus 


Compliance with ethical standards


Drs. Alhashemi, Fiore, Safa, Al Mahroos, Mata, Pecorelli, Baldini, Dendukuri, Stein, Liberman, Charlebios, Carli, and Feldman have no conflict of interest or financial ties to disclose.

Supplementary material

464_2018_6514_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mohsen Alhashemi
    • 1
    • 2
  • Julio F. FioreJr.
    • 1
    • 2
  • Nadia Safa
    • 1
  • Mohammed Al Mahroos
    • 1
    • 2
  • Juan Mata
    • 1
    • 2
  • Nicolò Pecorelli
    • 1
    • 2
  • Gabriele Baldini
    • 3
  • Nandini Dendukuri
    • 4
  • Barry L. Stein
    • 1
  • A. Sender Liberman
    • 1
  • Patrick Charlebois
    • 1
  • Franco Carli
    • 3
  • Liane S. Feldman
    • 1
    • 2
    • 5
    Email author
  1. 1.Department of SurgeryMcGill University Health CentreMontrealCanada
  2. 2.Steinberg-Bernstein Centre for Minimally Invasive Surgery and InnovationMcGill University Health CentreMontrealCanada
  3. 3.Department of AnesthesiaMcGill University Health CentreMontrealCanada
  4. 4.Department of Clinical EpidemiologyMcGill University Health Centre – Research InstituteMontrealCanada
  5. 5.Steinberg-Bernstein Centre for Minimally Invasive Surgery and InnovationMcGill University Health CentreMontrealCanada

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