Gastrointestinal motility has more of an impact on postoperative recovery than you might expect

Abstract

Purpose: While patient's reported autonomy (PRA) may help the physician to adapt the day of discharge, the link between postoperative ileus and length of stay and PRA is not known. The aim of this study was to evaluate the evolution of the PRA score during the postoperative period and to determine the factors possibly influencing such an evolution.

Methods: This retrospective study on a prospective database took place in a single centre over 14 months. PRA was defined by the by using part I of the Groningen Activity Restriction Scale known as activity of daily life [from 9 (best) to 45 (worst)].

Results: Among the 101 patients operated on for elective or emergent colorectal surgery, 80% of the patients had recovered their preoperative PRA (±5 points) before discharge and maintained their PRA during the 2 days preceding discharge. While PRA was significantly decreased by surgery (P<0.0001), each postoperative day allowed for its progressive recovery. Interestingly, the day of recovery of GI transit was associated with a significant increase of PRA (-6.96 points, P<0.0001). Despite high variability of baseline autonomy level, patients presented very similar recovery processes, which were represented by very low slope variability in the linear mixed model. Laparoscopy reduced the decrease of postoperative PRA (P=0.03) while ASA score>2 increased PRA (P=0.03). Age, emergency surgery and the occurrence of postoperative morbidity did not affect postoperative autonomy. Finally, enhanced recovery programs (ERP) tended to improve postoperative autonomy recovery (P=0.09).

Conclusion: PRA may be used as a means of optimising a patient's day of discharge following colorectal surgery.

Keywords: Autonomy; Gastrointestinal motility; Postoperative; Postoperative ileus.