Increased incidence of prolonged ileus after colectomy for inflammatory bowel diseases under ERAS protocol: a cohort analysis

Xujie Dai; Xiaolong Ge; Jianbo Yang; Tenghui Zhang; Tingbin Xie; Wen Gao; Jianfeng Gong; Weiming Zhu

doi:10.1016/j.jss.2016.12.031

Increased incidence of prolonged ileus after colectomy for inflammatory bowel diseases under ERAS protocol: a cohort analysis

J Surg Res. 2017 May 15:212:86-93. doi: 10.1016/j.jss.2016.12.031. Epub 2016 Dec 29.

Authors

Xujie Dai¹, Xiaolong Ge¹, Jianbo Yang¹, Tenghui Zhang¹, Tingbin Xie², Wen Gao¹, Jianfeng Gong³, Weiming Zhu¹

Affiliations

¹ Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
² Department of General Surgery, Jinling Hospital Affiliated to Southern Medical University, Nanjing, China.
³ Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of General Surgery, Jinling Hospital Affiliated to Southern Medical University, Nanjing, China. Electronic address: gongjianfeng@aliyun.com.

PMID: 28550927
DOI: 10.1016/j.jss.2016.12.031

Abstract

Background: Postoperative ileus is a common problem after colorectal surgery. The aim of the study was to investigate the incidence and risk factors for prolonged postoperative ileus (POI) after colectomy for inflammatory bowel diseases (IBDs).

Methods: Consecutive patients who underwent colorectal resection for IBD versus colorectal cancer (CRC) patients under enhanced recovery after surgery protocol were retrospectively analyzed. Primary assessment end point is the incidence of prolonged POI (>4 days); secondary end points were GI-2 recovery (time to first toleration of solid food and first bowel movement), nasogastric tube reinsertion, and postoperative length of stay. Risk factors for prolonged POI in IBD patients were assessed by multiple logistic regression analysis with P score matching.

Results: The incidence of prolonged POI was higher in IBD versus CRC group (28.8% versus 14.8%, P < 0.001). Patients with IBD had a longer time to GI-2 recovery (4.8 ± 2.1 versus 3.7 ± 1.4 d, P < 0.001), postoperative length of stay (10.7 ± 6.2 versus 7.9 ± 5.3 d, P < 0.001), higher incidence of nasogastric tube reinsertion (9.8% versus 4.0%, P = 0.02). After propensity-score matching analysis, the differences were still significant. Preoperative steroid use >20 mg/d (odds ratio, [OR] = 2.19, P = 0.048), hypoalbuminemia (<35 g/L; OR 2.72, P = 0.03), systemic inflammatory response syndrome status (OR 4.91, P = 0.03), and postoperative intraabdominal sepsis (OR 9.31, P = 0.001) were independent risk factors for prolonged POI in IBD patients.

Conclusions: In the setting of enhanced recovery after surgery, colectomy for IBD is associated with delayed gastrointestinal function recovery and higher incidence of prolonged POI compared to CRC patients. Normalizing preoperative albumin level, weaning off steroids, reducing preoperative systemic inflammatory response syndrome, and early management of postoperative intraabdominal sepsis may reduce POI in IBD population.

Keywords: Colorectal cancer; Colorectal surgery; Enhanced recovery after surgery; Inflammatory bowel diseases; Postoperative ileus.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Clinical Protocols
Colectomy*
Colorectal Neoplasms / surgery*
Female
Humans
Ileus / epidemiology
Ileus / etiology*
Incidence
Inflammatory Bowel Diseases / surgery*
Logistic Models
Male
Middle Aged
Perioperative Care* / methods
Postoperative Complications / epidemiology
Postoperative Complications / etiology*
Retrospective Studies
Risk Factors
Treatment Outcome
Young Adult