Epidemiology, Pathophysiology and Medical Management of Postoperative Ileus in the Elderly

Abstract

As the population of the Western world ages, the number of major surgical procedures performed in the elderly population will by necessity increase. Within virtually every surgical specialty, studies have shown that patients should not be denied surgery on the basis of chronological age alone. It has recently been recognized that physiological age is far more important within the decision-making algorithm as to whether or not to proceed with major surgery in the septuagenarian and octogenarian populations and beyond. Not unexpectedly, not only the results of these operations, but also the associated morbidities, are similar in older and younger populations. Therefore, it is not surprising that postoperative ileus (POI) affects patients of all ages. POI is a multifactorial condition that is exacerbated by opioid analgesics, bed rest and other conditions that may be rather prevalent in the postoperative elderly patient. Therefore, as major surgical interventions are considered in this population, appropriate assessment and, ideally, correction of any physiological disturbances should be undertaken along with implementation of standardized enhanced recovery protocols. Ideally, through this combined approach, an appreciable impact can be made on reducing POI while controlling postoperative pain and limiting postoperative thromboembolic, cardiopulmonary, cerebral and infectious complications. This article reviews the potential impact of pharmacological agents, laparoscopy and other manoeuvres on POI in the elderly.

Risk Factors for Post-operative Ileus: A Retrospective Study in Tertiary Referral Hospital in Indonesia

“…This study found that age of 65 years old or older and duration of surgery are the risk factor associated with post-operative ileus with RR of 5.96 and 6.14, respectively. Hirayasa et al found that the risk of post-operative ileus is higher in elderly patients who undergone colorectal surgery (65 years old or older) compare to younger population (1.8 -19.6 vs. 0.8 -7.9) [7]. Some other studies are in line with the finding of this study.…”

Does an extreme age (≥80 years) affect outcomes in patients after liver cancer surgery? A meta‐analysis

“…An advanced age might correlate with a higher prevalence of POI because elderly patients are more vulnerable to surgical stress, which might more easily cause impaired bowel contractility and motility as well as gut wall edema . Strategies including laparoscopic technique, fast‐track recovery protocol and early enteral nutritional support can reduce POI and promote post‐operative recovery …”

A systematic review of enhanced recovery care after colorectal surgery in elderly patients

“…Elderly patients have higher levels of comorbidity, frailty and social care requirements . It may be argued that the elderly need strategies such as ERAS to optimize speed of recovery and to avoid postoperative complications and their sequelae . The aim of this review was to determine the evidence for the safety, feasibility and efficacy of an enhanced recovery programme after colorectal surgery in elderly patients.…”