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

Alhashemi, Mohsen; Fiore, Julio F.; Safa, Nadia; Mahroos, Mohammed Al; Mata, Juan; Pecorelli, Nicolò; Baldini, Gabriele; Dendukuri, Nandini; Stein, Barry; Liberman, Alexander; Charlebois, Patrick; Carli, Franco; Feldman, Liane S.

doi:10.1007/s00464-018-6514-4

Cited by 48 publications

(37 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The longer operation time and the temporary edema due to intensive manipulation during hand anastomoses could explain this [ 30 ]. Ιn line with previous studies, the postoperative opioid use was related to the development of upper PPOI [ 31 ]. Opioid analgesia effects on GI function and its impact on PPOI have been well studied before, as it causes hypomotility via activation of peripherally acting m-opioid receptors [ 26 , 32 – 35 ].…”

Section: Discussionsupporting

confidence: 86%

Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease

Pozios

Seeliger

Lauscher

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Prolonged postoperative ileus (PPOI) is common after bowel resections, especially in Crohn’s disease (CD). The pathophysiology of PPOI is not fully understood. PPOI could affect only the upper or lower gastrointestinal (GI) tract. The aim of this study was to assess risk factors for diverse types of PPOI, particularly to differentiate PPOI of upper and lower GI tract. Methods A retrospective analysis of 163 patients with CD undergoing ileocecal resection from 2015 to 2020 in a single center was performed. PPOI of the upper GI tract was predefined as the presence of vomiting or use of nasogastric tube longer than the third postoperative day. Lower PPOI was predefined as the absence of defecation for more than three days. Independent risk factors were identified by multivariable logistic regression analysis. Results Overall incidence of PPOI was 42.7%. PPOI of the upper GI tract was observed in 30.7% and lower PPOI in 20.9% of patients. Independent risk factors for upper PPOI included older age, surgery by a resident surgeon, hand-sewn anastomosis, prolonged opioid analgesia, and reoperation, while for lower PPOI included BMI ≤ 25 kg/m2, preoperative anemia, and absence of ileostomy. Conclusion This study identified different risk factors for upper and lower PPOI after ileocecal resection in patients with CD. A differentiated upper/lower type approach should be considered in future research and clinical practice. High-risk patients for each type of PPOI should be closely monitored, and modifiable risk factors, such as preoperative anemia and opioids, should be avoided if possible.

show abstract

Section: Discussionsupporting

confidence: 86%

Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease

Pozios

Seeliger

Lauscher

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…Delayed recovery of bowel function is common after elective colorectal surgery. Prolonged postoperative ileus (PPOI) occurs in approximately 19% of patients postoperatively and is associated with an increased length of stay (LOS), risk of complications and a 71% increase in healthcare costs [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Prolonged postoperative ileus following right‐ versus left‐sided colectomy: A systematic review and meta‐analysis

et al. 2021

View full text Add to dashboard Cite

Aim: Prolonged postoperative ileus (PPOI) is a common complication following colonic surgery, and is associated with longer hospital stay, greater risk of complications and substantial cost for patients and hospitals. Some reports have recently suggested that gastrointestinal (GI) recovery varies based on the side of resection (i.e., right-sided vs. left-sided colectomy). This systematic review and meta-analysis aimed to compare GI recovery by resection side. Methods:The MEDLINE, Embase, Cochrane Library and CENTRAL databases were systematically searched for articles reporting GI recovery outcomes in adults undergoing elective right-versus left-sided colectomy (excluding with ileostomy) of any surgical approach. The primary outcome was PPOI, and secondary outcomes included time to first passage of flatus, stool and tolerance of solid diet, and postoperative complications.Subgroup analyses of laparoscopic procedures and cohorts without inflammatory bowel disease and sensitivity analysis of adjusted multivariate results were also performed.Results: Nine studies were identified, of which seven were included in the meta-analysis, comprising 29 068 colectomies (14 581 right-sided; 14 487 left-sided). PPOI was heterogeneously defined and was significantly more likely following right-sided compared to left-sided colectomy regardless of the surgical approach (OR 1.78, 95% CI 1.32-2.39; P < 0.01; I 2 = 51%), as well as on subgroup analyses and adjusted multivariate metaanalysis. Secondary outcomes were reported in only a few small studies; hence metaanalysis did not produce reliable results. Conclusion:Based on heterogeneous definitions, consistently higher rates of PPOI were observed following right-versus left-sided colectomy. These differences are currently unexplained and highlight the need for further research into the pathophysiology of ileus.

show abstract

“…POI has a multifactorial etiology and can deeply affect the patient's recovery, lengthening hospital stay and increasing costs [105,106]. The incidence of POI after colorectal surgery ranges from 15 to 19% [107,108] and 60% of patients have a severe clinical presentation [82]. Intraoperative blood loss, administration of any intravenous opioids in the first 48 h, postoperative epidural analgesia and non-compliance with intraoperative fluid management protocols are predictors of POI [109].…”

Section: Considerationsmentioning

confidence: 99%

Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper

et al. 2020

View full text Add to dashboard Cite

Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann’s procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure.

show abstract

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

Cited by 48 publications

References 46 publications

Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease

Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease

Prolonged postoperative ileus following right‐ versus left‐sided colectomy: A systematic review and meta‐analysis

Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper

Contact Info

Product

Resources

About