PyRICo‐Pilot: pyridostigmine to reduce the duration of postoperative ileus after colorectal surgery – a phase II study

Dudi-Venkata, Nagendra N; Kroon, Hidde M.; Bedrikovetski, Sergei; Traeger, Luke; Lewis, Mark; Lawrence, Matthew; Hunter, Ronald; Moore, James W.; Thomas, Michelle; Sammour, Tarik

doi:10.1111/codi.15748

Cited by 10 publications

(14 citation statements)

References 44 publications

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“…Patients suffering POI were more likely to have an increase in theatre time (163.0 vs. 147.5 min, p = 0.021), and increased amount of postoperative day one to four analgesia given (119.25 vs. 120.0 MEQ, p < 0.001). Patients participating in the STIMULAX and PyRICo‐P trials at our institution had equal distribution between non‐POI and POI groups [22,23]. These and other baseline characteristics and differences between the POI and non‐POI groups are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…[17] Univariate and multivariate linear regression analyses were performed on variables chosen a priori on log-normal transformed total cost of inpatient stay, to determine independent predictors of total cost of inpatient stay. Statistical significance was accepted at p < 0.05. and POI groups [22,23]. These and other baseline characteristics and differences between the POI and non-POI groups are presented in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…The 34.9% POI rate in our study is higher than in previous reports (8.5%-27%) [12][13][14][15][16], which could reflect the different POI definitions used, the inclusion of minor procedures in other studies, and under-reporting of POI. This may reflect that fact that many of the patients in the current study participated in clinical trials [22,23] specifically investigating POI (an interest of our research group), the strict POI definition used according to GI-2, and the fact that complications in our Department are recorded prospectively. Mao et al [16] reported a POI rate of 27%, also using strict criteria of symptoms for POI diagnosis such as nausea or vomiting, tolerance of solid diet, abdominal distension, absence of flatus and stools, and radiological evidence on X-ray or computed tomography.…”

Section: Discussionmentioning

confidence: 99%

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Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

et al. 2022

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Aim Postoperative ileus (POI) following surgery results in significant morbidity, drastically increasing hospital costs. As there are no specific Australian data, this study aimed to measure the cost of POI after colorectal surgery in an Australian public hospital. Methods A cost analysis was performed, for major elective colorectal surgical cases between 2018 and 2021 at the Royal Adelaide Hospital. POI was defined as not achieving GI‐2, the validated composite measure, by postoperative day 4. Demographics, length of stay and 30‐day complications were recorded retrospectively. Costings in Australian dollars were collected from comprehensive hospital billing data. Univariate and multivariate analyses were performed. Results Of the 415 patients included, 34.9% (n = 145) developed POI. POI was more prevalent in males, smokers, previous intra‐abdominal surgery, and converted laparoscopic surgery (p < 0.05). POI was associated with increased length of stay (8 vs. 5 days, p < 0.001) and with higher rates of complications such as pneumonia (15.2% vs. 8.1%, p = 0.027). Total cost of inpatient care was 26.4% higher after POI (AU$37,690 vs. AU$29,822, p < 0.001). POI was associated with increased staffing costs, as well as diagnostics, pharmacy, and hospital services. On multivariate analysis POI, elderly patients, stoma formation, large bowel surgery, prolonged theatre time, complications and length of stay were predictive of increased costs (p < 0.05). Conclusion In Australia, POI is significantly associated with increased complications and higher costs due to prolonged hospital stay and increased healthcare resource utilisation. Efforts to reduce POI rates could diminish its morbidity and associated expenses, decreasing the burden on the healthcare system.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

et al. 2022

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“…In our own experience, we have safely administered pyridostigmine in a phase 2 study to prevent POI in 15 colorectal patients. There were no adverse effects with a time to stool and toleration of solid diet of 2 days (IQR 1–4) 41 …”

Section: Acetylcholinesterase Inhibitorsmentioning

confidence: 97%

“…There were no adverse effects with a time to stool and toleration of solid diet of 2 days (IQR 1-4). 41 Discussion POI is a significant complication, increasing morbidity and length of stay, particularly following colorectal surgery. 7,11,12 With modern ERPs, methods of reducing length of stay have been investigated, such as laxatives and alvimopam.…”

Section: Pyridostigmine For Poimentioning

confidence: 99%

The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review

Traeger

Kroon

Bedrikovetski

et al. 2021

ANZ Journal of Surgery

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Postoperative ileus is a common complication in the days following colorectal surgery occurring in up to 50% of patients. When prolonged, this complication results in significant morbidity and mortality, doubling the total costs of hospital stay. Postoperative ileus (POI) results from the prolonged inflammatory phase that is mediated in part by the cholinergic anti‐inflammatory pathway. Acetylcholinesterase inhibitors, such as neostigmine and pyridostigmine, delay the degradation of acetylcholine at the synaptic cleft. This increase in acetylcholine has been shown to increase gut motility. They have been effective in the treatment of acute colonic pseudo‐obstruction, but there is limited evidence for the use of these medications for reducing the incidence of POI. This review was conducted to summarise the evidence of acetylcholinesterase inhibitors' effect on gut motility and discuss their potential use as part of an enhanced recovery protocols to prevent or treat POI.

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Effect of neuromuscular reversal with neostigmine/glycopyrrolate versus sugammadex on postoperative ileus following colorectal surgery

et al. 2022

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Background Postoperative ileus (POI) is a common complication following colorectal surgery and is mediated in part by the cholinergic anti-inflammatory pathway (CAIP). Neostigmine (acetylcholinesterase inhibitor), co-administered with glycopyrrolate, is frequently given for neuromuscular reversal before tracheal extubation and modulates the CAIP. An alternative reversal agent, sugammadex (selective rocuronium or vecuronium binder), acts independently from the CAIP. The aim of our study was to assess the impact of neuromuscular reversal agents used during anaesthesia on gastrointestinal recovery. Methods Three hundred thirty-five patients undergoing elective colorectal surgery at the Royal Adelaide Hospital between January 2019 and December 2021 were retrospectively included. The primary outcome was GI-2, a validated composite measure of time to diet tolerance and passage of stool. Demographics, 30-day complications and length of stay were collected. Univariate and multivariate analyses were performed. Results Two hundred twenty-four (66.9%) patients (129 [57.6%] males and 95 [42.4%] females, median age 64 [19–90] years) received neostigmine/glycopyrrolate and 111 (33.1%) received sugammadex (62 [55.9%] males and 49 [44.1%] females, median age 67 [18–94] years). Sugammadex patients achieved GI-2 sooner after surgery (median 3 (0–10) vs. 3 (0–12) days, p = 0.036), and reduced time to first stool (median 2 (0–10) vs. 3 (0–12) days, p = 0.035). Rates of POI, complications and length of stay were similar. On univariate analysis, POI was associated with smoking history, previous abdominal surgery, colostomy formation, increased opioid use and postoperative hypokalaemia (p < 0.05). POI was associated with increased complications, including anastomotic leak and prolonged hospital stay (p < 0.001). On multivariate analysis, neostigmine, bowel anastomoses and increased postoperative opioid use (p < 0.05) remained predictive of time to GI-2. Conclusions Patients who received sugammadex had a reduced time to achieving first stool and GI-2. Neostigmine use, bowel anastomoses and postoperative opioid use were associated with delayed time to achieving GI-2.

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PyRICo‐Pilot: pyridostigmine to reduce the duration of postoperative ileus after colorectal surgery – a phase II study

Cited by 10 publications

References 44 publications

Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting

The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review

Effect of neuromuscular reversal with neostigmine/glycopyrrolate versus sugammadex on postoperative ileus following colorectal surgery

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