Targets for Intervention? Preoperative Predictors of Postoperative Ileus After Colorectal Surgery in an Enhanced Recovery Protocol.

Adolescent Cohort Studies Colorectal Surgery Digestive System Surgical Procedures Humans Ileus / epidemiology Length of Stay Postoperative Complications / epidemiology Retrospective Studies
Colorectal Surgery Enhanced Recovery Protocol Postoperative ileus

Journal

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084

Informations de publication

Date de publication:
08 2021
Historique:
received: 20 08 2020
accepted: 10 11 2020
pubmed: 19 11 2020
medline: 6 8 2021
entrez: 18 11 2020
Statut: ppublish

Résumé

Postoperative ileus occurs in up to 30% of colorectal surgery patients and is associated with increased length of stay, costs, and morbidity. While Enhanced Recovery Protocols seek to accelerate postoperative recovery, data on modifiable preoperative factors associated with postoperative ileus in this setting are limited. We aimed to identify preoperative predictors of postoperative ileus following colorectal surgery in Enhanced Recovery Protocols, to determine new intervention targets. We performed a retrospective single-center cohort study of patients ≥ 18 years old who underwent colorectal surgery via Enhanced Recovery Protocols (7/2015-7/2017). Postoperative ileus was defined as nasogastric tube insertion postoperatively or nil-per-os by postoperative day 4. Preoperative risk factors including comorbidities and medication use were identified using multivariable stepwise logistic regression. Of 530 patients, 14.9% developed postoperative ileus. On univariate analysis of perioperative and postoperative factors, postoperative ileus patients had increased psychiatric illness, antidepressant and antipsychotic use, American Society of Anesthesiologists classification, ileostomy creation, postoperative opioid use, complications, surgery duration, and length of stay (p < 0.05). Multivariable logistic regression model for preoperative factors identified psychiatric illness, preoperative antipsychotic use, and American Society of Anesthesiologists classification ≥ 3 as significant predictors of postoperative ileus (p < 0.05). Postoperative ileus remains a common complication following colorectal surgery under Enhanced Recovery Protocols. Patients with pre-existing psychiatric comorbidities and preoperative antipsychotic use may be a previously overlooked cohort at increased risk for postoperative ileus. Additional research and preoperative interventions within Enhanced Recovery Protocols to reduce postoperative ileus for this higher-risk population are needed.

Sections du résumé

BACKGROUND
Postoperative ileus occurs in up to 30% of colorectal surgery patients and is associated with increased length of stay, costs, and morbidity. While Enhanced Recovery Protocols seek to accelerate postoperative recovery, data on modifiable preoperative factors associated with postoperative ileus in this setting are limited. We aimed to identify preoperative predictors of postoperative ileus following colorectal surgery in Enhanced Recovery Protocols, to determine new intervention targets.
METHODS
We performed a retrospective single-center cohort study of patients ≥ 18 years old who underwent colorectal surgery via Enhanced Recovery Protocols (7/2015-7/2017). Postoperative ileus was defined as nasogastric tube insertion postoperatively or nil-per-os by postoperative day 4. Preoperative risk factors including comorbidities and medication use were identified using multivariable stepwise logistic regression.
RESULTS
Of 530 patients, 14.9% developed postoperative ileus. On univariate analysis of perioperative and postoperative factors, postoperative ileus patients had increased psychiatric illness, antidepressant and antipsychotic use, American Society of Anesthesiologists classification, ileostomy creation, postoperative opioid use, complications, surgery duration, and length of stay (p < 0.05). Multivariable logistic regression model for preoperative factors identified psychiatric illness, preoperative antipsychotic use, and American Society of Anesthesiologists classification ≥ 3 as significant predictors of postoperative ileus (p < 0.05).
DISCUSSION
Postoperative ileus remains a common complication following colorectal surgery under Enhanced Recovery Protocols. Patients with pre-existing psychiatric comorbidities and preoperative antipsychotic use may be a previously overlooked cohort at increased risk for postoperative ileus. Additional research and preoperative interventions within Enhanced Recovery Protocols to reduce postoperative ileus for this higher-risk population are needed.

Identifiants

DOI: 10.1007/s11605-020-04876-0 PMID: 33205308 PMC: PMC8126638
pubmed: 33205308
doi: 10.1007/s11605-020-04876-0
pii: 10.1007/s11605-020-04876-0
pmc: PMC8126638
mid: NIHMS1647588
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

2065-2075

Subventions

Organisme : NHLBI NIH HHS
ID : T32 HL007820
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR001858
Pays : United States

Informations de copyright

© 2020. The Society for Surgery of the Alimentary Tract.

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Auteurs

Cindy Y Teng (CY)

Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
ORCID: 0000-0002-2611-1791

Sara Myers (S)

Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.

Tanya S Kenkre (TS)

Epidemiology Data Center Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.

Luke Doney (L)

Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, USA.

Wai Lok Tsang (WL)

Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL, USA.

Kathirvel Subramaniam (K)

Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Stephen A Esper (SA)

Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Jennifer Holder-Murray (J)

Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. holdermurrayjm@upmc.edu.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. holdermurrayjm@upmc.edu.

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