The clinical and economical impact of postoperative ileus in patients undergoing colorectal surgery

Abstract

Background Colorectal surgery is associated with postoperative ileus (POI). Despite its widespread manifestation, the influence of POI on recovery, quality of life (QoL), and costs is largely unknown. The aim of this study was to assess whether the inflammatory processes found in experimental studies are also evident in patients undergoing colorectal surgery. In addition, the impact of POI on short and long‐term QoL and costs was investigated. Methods We analyzed the outcomes of the SANICS‐II trial, including prospective evaluation of inflammatory parameters in blood samples, costs from a societal perspective and QoL, using validated questionnaires. Outcomes were compared between patients with and without POI, and in particular patients with POI as unique complication. Key Results A total of 265 patients (POI, n = 66 vs non‐POI, n = 199) were included and 38/66 had POI as only complication. CRP levels were significantly increased on postoperative day (POD) 1, 2, 3, and 4 in patients with POI. Furthermore, plasma levels of cytokines IL‐6, Il‐8 and IL‐10 were significantly increased the first 2 days after resection. Patients with POI had a higher overall complication rate and a reduced QoL 3 months postoperatively, even in the only POI group. Moreover, mean societal cost per patient with POI was 38%‐47% higher at 3 months postoperatively. Conclusions & Inferences Supporting findings from experimental studies, inflammatory parameters were increased in patients with only POI and comparable with all patients with POI. These results demonstrate the impact and large contribution of POI in postoperative inflammation, costs and QoL in patients undergoing colorectal surgery.

Postoperative ileus—An ongoing conundrum

“…In human patients with postoperative ileus, infiltration of leukocytes developed and inflammatory markers (leukotrienes) increased in the serum. 13 Similar activation also occurred in the murine colon when it was handled or a portion removed (analogous to the majority of human surgeries). 46 Similar observations have been made in samples from resected human intestine.…”

“…Using a tight definition of ileus, the rate was still considerable after laparoscopic surgery. 13,91 It needs to be emphasized that the primary aim of an oncological operation is a complete dissection to remove the tumor and ligate the blood vessels centrally.…”

“…1 It is very distressing for the patient and for the treating doctors and is costly in terms of extended hospitalization. 13 In 2010 in the United States, it incurred estimated costs of $750 M per year. 3 A more recent study in New Zealand indicated that inpatient costs for patients with prolonged ileus were 71% higher than inpatients without the condition ($27,981/patient v $16,317/patient).…”

Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols

“…It is also possible and quite probable that POGD may represent short-and long-term complications during the acute phase involving inflammation, and long term after inflammation has resolved and the patient leaves the hospital. A recent study in neurogastroenterology and motility provided proof of concept, by showing for the first time that POI significantly decreases the quality of life at 3 and 6 months (QoL) (Peters et al, 2020). Therefore, it would be prudent to incorporate quality of life questionnaires in the CERAS protocols and extending the timeline to a longer postoperative period to uncover potential complications occurring after intestinal or systemic inflammation has resolved to further investigate long-term outcomes and mechanisms in POGD.…”

Risk factors and outcomes associated with postoperative ileus following ileostomy formation: a retrospective study

“…Postoperative ileus (POI) after abdominal colorectal surgery is associated with increased patient discomfort, hospital length of stay (LOS), and cost of care (Peters et al, 2020 ). Minimally invasive surgery and the elimination of opioid use are widely accepted, evidence-based measures to reduce POI (Chapman et al, 2018 ).…”