Abstract
Background
Prolonged ileus is one of the most common postoperative complications after colorectal surgery. We sought to investigate the predictors of prolonged ileus following elective colon resections procedures.
Methods
The national participant user files of NSQIP databases were utilized to examine the clinical outcomes of patients undergoing elective colon resection during 2012–2013. Multivariate regression analysis was performed to investigate predictors of prolonged ileus. Prolonged ileus was defined as no return of bowel function in 7 days.
Results
We sampled a total of 27,560 patients who underwent colon resections; of these, 3497 (12.7 %) patients had prolonged ileus. Patients with ileocolonic anastomosis (ICA) had a significantly higher rate of prolonged ileus compared to patients with colorectal anastomosis (CRA) (15 vs. 11.5 %, AOR 1.25, P < 0.01). Prolonged ileus was significantly associated with intra-abdominal infections (13 vs. 2.8 %, AOR 2.56, P < 0.01) and anastomotic leakage (12 vs. 2.4 %, AOR 2.50, P < 0.01). Factors such as preoperative sepsis (AOR 1.63, P < 0.01), disseminated cancer (AOR 1.24, P = 0.01), and chronic obstructive pulmonary disease (AOR 1.27, P = 0.02) were associated with an increased risk of prolonged ileus, whereas oral antibiotic bowel preparation (AOR 0.77, P < 0.01) and laparoscopic surgery (AOR 0.51, P < 0.01) are associated with decreased prolonged ileus risk.
Conclusions
Prolonged ileus is a common condition following colon resection, with an incidence of 12.7 %. Among colon surgeries, colectomy with ICA resulted in the highest rate of postoperative prolonged ileus. Prolonged ileus is positively associated with anastomotic leak and intra-abdominal infections; thus, a high index of suspicion must be had in all patients with prolonged postoperative ileus.
Similar content being viewed by others
References
Kronberg U, Kiran RP, Soliman MS, Hammel JP, Galway U, Coffey JC et al (2011) A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg 253:78–81
Iyer S, Saunders WB, Stemkowski S (2009) Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm 15:485–494
Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E (2012) Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg 36:179–185
Delaney C, Kehlet H, Senagore AJ, Bauer AJ, Beart R, Billingham R et al (2006) (eds) Clinical consensus update in general surgery [Internet] Roswell: pharmatecture, LLC; [cited 2015 Feb 1]. http://www.clinicalwebcasts.com/pdfs/GenSurg_WEB.pdf
Livingston EH, Passaro EP (1990) Postoperative ileus. Dig Dis Sci 35:121–132
Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87:1480–1493
Forbes A (2014) Crohn’s disease: rehabilitation after resection. Dig Dis 32:395–398
Bueno L, Fioramonti J, Delvaux M, Frexinos J (1997) Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations. Gastroenterology 112:1714–1743
Luckey A, Livingston E, Taché Y (2003) Mechanisms and treatment of postoperative ileus. Arch Surg 138:206–214
Köninger J, Gutt CN, Wente MN, Friess H, Martin E, Büchler MW (2006) Postoperative ileus. Pathophysiology and prevention. Chirurg 77:904–912
Artinyan A, Nunoo-Mensah JW, Balasubramaniam S, Gauderman J, Essani R, Gonzalez-Ruiz C et al (2008) Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World J Surg 32:1495–1500
Shibata Y, Toyoda S, Nimura Y, Miyati M (1997) Patterns of intestinal motility recovery during the early stage following abdominal surgery: clinical and manometric study. World J Surg 21:806–809 (discussion 809–810)
National Surgical Quality Improvement Program (2005) [home page on the Internet] Chicago, IL: American College of Surgeons. [cited 2015 Jan 17]. www.acsnsqip.org
Böhm B, Milsom JW, Fazio VW (1995) Postoperative intestinal motility following conventional and laparoscopic intestinal surgery. Arch Surg 130:415–419
Holte K, Kehlet H (2002) Prevention of postoperative ileus. Minerva Anestesiol 68:152–156
Polacek MA, Close AS (1963) The effect of antibiotic bowel preparation and peritoneal irrigation on the duration of post-operative ileus. Am J Surg 105:768–770
Kalff JC, Carlos TM, Schraut WH, Billiar TR, Simmons RL, Bauer AJ (1999) Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 117:378–387
Espat NJ, Cheng G, Kelley MC, Vogel SB, Sninsky CA, Hocking MP (1995) Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus. J Surg Res 58:719–723
De Winter BY, Robberecht P, Boeckxstaens GE, De Man JG, Moreels TG, Herman AG et al (1998) Role of VIP1/PACAP receptors in postoperative ileus in rats. Br J Pharmacol 124:1181–1186
Lorence DP, Ibrahim IA (2003) Benchmarking variation in coding accuracy across the United States. J Health Care Finance 29:29–42
Disclosures
Dr. Stamos has received educational grants and speaker fees paid to the Department of Surgery, University of California, Irvine, from Ethicon, Gore, Covidien, and Olympus. Dr. Mills and Dr. Carmichael received Ethicon educational grants paid to the Department of Surgery, University of California, Irvine. Dr. Pigazzi is a consultant for Intuitive Surgical and has also received consultancy fees and educational grants paid to the Department of Surgery, University of California, Irvine. Dr. Moghadamyeghaneh, Dr. Phelan, Dr. Hwang, and Dr. Hanna have no disclosures. Dr. Moghadamyeghaneh had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moghadamyeghaneh, Z., Hwang, G.S., Hanna, M.H. et al. Risk factors for prolonged ileus following colon surgery. Surg Endosc 30, 603–609 (2016). https://doi.org/10.1007/s00464-015-4247-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4247-1