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Ileus rate after abdominal wall reconstruction: a retrospective analysis of two clinical trials

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Abstract

Purpose

Postoperative ileus (POI) is the paralytic disruption of gastrointestinal motility, a common complication following abdominal wall reconstruction that often leads to increased patient morbidity and length of stay (LOS). We reviewed two randomized clinical trials to determine POI rates, predictive factors, LOS, and associated cost.

Methods

Two randomized trials were performed from 2017–2019 with all patients receiving elective open abdominal wall reconstruction with retromuscular mesh. Using multivariate logistic regression, we performed a retrospective analysis including demographics and operative details from patients at a single site to determine predictive factors for POI. All medical costs encompassing surgery and the 30-day postoperative period were compared between ileus and non-ileus groups.

Results

Four hundred and seventy patients were reviewed with a POI rate of 13.0% (N = 61). There were no differences in age, body mass index (BMI), history of abdominal surgery, or comorbidities between patients with and without POI. Logistic regression showed no association with POI and age, BMI, hernia width, or operative time lasting longer than 4 h. Median LOS was 8 days for patients with POI compared to five for those without (p < 0.001). Relative median 30-day costs were 1.19 in patients with ileus and 1.0 in those without (p < 0.001).

Conclusion

We identified a 13% rate of POI in patients undergoing open abdominal wall reconstruction with mesh with no clearly identified predisposing factors. This resulted in a 3 days increase in median LOS and 19% additional costs. Further efforts should be devoted to investigating interventions that may reduce postoperative ileus after abdominal wall reconstruction.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    C. D. Greco & J. D. Thomas

  2. Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA

    C. C. Petro, K. Montelione, A. Fafaj, S. Zolin, D. Krpata, S. Rosenblatt, M. Rosen, L. Beffa & A. Prabhu

  3. Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA

    C. Tu

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  1. C. D. Greco
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Contributions

ASP: intuitive research support and speaking honoraria, CMR: surgical consulting fees, verb surgical consulting fees. MJR receives salary support for his role as the medical director of the Abdominal Core Health Quality Collaborative; board member of Ariste Medical Inc. and has stocks from Ariste Medical. DMK: received an educational grant from W.L. Gore. AF: resident research grant from the Americas Hernia Society Quality Collaborative.

Corresponding author

Correspondence to A. Prabhu.

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None of these conflicts of interest are related to the submitted work. All other authors report no conflicts of interest.

Human and animal rights, and Informed consent

This work received exemption from our Institutional Review Board and did not involve human and animal rights, ethical approval, or informed consent because the work is retrospective.

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Greco, C.D., Petro, C.C., Thomas, J.D. et al. Ileus rate after abdominal wall reconstruction: a retrospective analysis of two clinical trials. Hernia 26, 1591–1598 (2022). https://doi.org/10.1007/s10029-022-02687-7

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