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Targets for Intervention? Preoperative Predictors of Postoperative Ileus After Colorectal Surgery in an Enhanced Recovery Protocol

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Postoperative ileus occurs in up to 30% of colorectal surgery patients and is associated with increased length of stay, costs, and morbidity. While Enhanced Recovery Protocols seek to accelerate postoperative recovery, data on modifiable preoperative factors associated with postoperative ileus in this setting are limited. We aimed to identify preoperative predictors of postoperative ileus following colorectal surgery in Enhanced Recovery Protocols, to determine new intervention targets.

Methods

We performed a retrospective single-center cohort study of patients ≥ 18 years old who underwent colorectal surgery via Enhanced Recovery Protocols (7/2015–7/2017). Postoperative ileus was defined as nasogastric tube insertion postoperatively or nil-per-os by postoperative day 4. Preoperative risk factors including comorbidities and medication use were identified using multivariable stepwise logistic regression.

Results

Of 530 patients, 14.9% developed postoperative ileus. On univariate analysis of perioperative and postoperative factors, postoperative ileus patients had increased psychiatric illness, antidepressant and antipsychotic use, American Society of Anesthesiologists classification, ileostomy creation, postoperative opioid use, complications, surgery duration, and length of stay (p < 0.05). Multivariable logistic regression model for preoperative factors identified psychiatric illness, preoperative antipsychotic use, and American Society of Anesthesiologists classification ≥ 3 as significant predictors of postoperative ileus (p < 0.05).

Discussion

Postoperative ileus remains a common complication following colorectal surgery under Enhanced Recovery Protocols. Patients with pre-existing psychiatric comorbidities and preoperative antipsychotic use may be a previously overlooked cohort at increased risk for postoperative ileus. Additional research and preoperative interventions within Enhanced Recovery Protocols to reduce postoperative ileus for this higher-risk population are needed.

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Acknowledgments

The authors thank Hesper Wong and Sofiane Lazar for their assistance with data collection.

Funding

Cindy Teng was partially supported by the National Institutes of Health Training Grant (T32 HL007820). Sara Myers was partially supported by the National Center for Advancing Translational Sciences (5TL1TR001858-02).

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Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Cindy Y. Teng, Sara Myers & Jennifer Holder-Murray

  2. Epidemiology Data Center Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Tanya S. Kenkre

  3. Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, USA

    Luke Doney

  4. Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL, USA

    Wai Lok Tsang

  5. Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Kathirvel Subramaniam, Stephen A. Esper & Jennifer Holder-Murray

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  1. Cindy Y. Teng
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Contributions

Cindy Y. Teng, MD: concept and design, data acquisition, analysis and interpretation, drafting/revision, and final approval of manuscript.

Sara Myers, MD, PhD: data analysis and interpretation, revision, and final approval of manuscript.

Tanya S. Kenkre, PhD, MPH: analysis and interpretation, drafting/revision, and final approval of manuscript.

Luke Doney, DO: data acquisition, revision, and final approval of manuscript.

Wai Lok Tsang, MD: data acquisition, revision, and final approval of manuscript.

Stephen A. Esper, MD, MBA: data interpretation, drafting/revision, and final approval of manuscript.

Kathirvel Subramaniam, MD, MPH: concept and design, data interpretation, drafting/revision, and final approval of manuscript.

Jennifer Holder-Murray, MD: concept and design, data interpretation, drafting/revision, and final approval of manuscript.

Corresponding author

Correspondence to Jennifer Holder-Murray.

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The authors declare that they have no conflicts of interest.

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Prior presentation

This paper has been presented as a poster presentation at the American Society of Colon and Rectal Surgeons 2019 annual scientific meeting in Cleveland, OH held June 1–5, 2019.

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Teng, C.Y., Myers, S., Kenkre, T.S. et al. Targets for Intervention? Preoperative Predictors of Postoperative Ileus After Colorectal Surgery in an Enhanced Recovery Protocol. J Gastrointest Surg 25, 2065–2075 (2021). https://doi.org/10.1007/s11605-020-04876-0

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