Association of Abdominal Incision Length With Gastrointestinal Function Recovery Post-operatively: A Multicenter Registry System-Based Retrospective Cohort Study

Jianning Song; Yingchi Yang; Wenxian Guan; Gang Jin; Yinmo Yang; Lin Chen; Yong Wan; Leping Li; Qingsi He; Wei Zhang; Weiming Zhu; Lei Chen; Dianrong Xiu; Weijun Tian; Daogui Yang; Wenhui Lou; Zhongtao Zhang

doi:10.3389/fsurg.2021.743069

Association of Abdominal Incision Length With Gastrointestinal Function Recovery Post-operatively: A Multicenter Registry System-Based Retrospective Cohort Study

Front Surg. 2021 Oct 25:8:743069. doi: 10.3389/fsurg.2021.743069. eCollection 2021.

Authors

Jianning Song¹, Yingchi Yang¹, Wenxian Guan², Gang Jin³, Yinmo Yang⁴, Lin Chen⁵, Yong Wan⁶, Leping Li⁷, Qingsi He⁸, Wei Zhang⁹, Weiming Zhu¹⁰, Lei Chen¹¹, Dianrong Xiu¹², Weijun Tian¹³, Daogui Yang¹⁴, Wenhui Lou¹⁵, Zhongtao Zhang¹

Affiliations

¹ Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China.
² Nanjing Drum Tower Hospital Affiliated With Nanjing University Medical School, Nanjing, China.
³ Changhai Hospital, Shanghai, China.
⁴ Peking University First Hospital, Beijing, China.
⁵ The General Hospital of the People's Liberation Army First Medical Center, Beijing, China.
⁶ Yantaishan Hospital, Shandong, China.
⁷ Shandong Province Hospital, Jinan, China.
⁸ Qilu Hospital of Shandong University, Jinan, China.
⁹ Jiangxi Province People's Hospital, Nanchang, China.
¹⁰ Nanjing General Hospital of Nanjing Military Command, Nanjing, China.
¹¹ Qilu Hospital of Shandong University, Qingdao, China.
¹² Peking University Third Hospital, Beijing, China.
¹³ General Hospital of Tianjin Medical University, Tianjin, China.
¹⁴ Liaocheng People's Hospital, Liaocheng, China.
¹⁵ Zhongshan Hospital Affiliated With Fudan University, Shanghai, China.

Abstract

Objective: To evaluate the influence of the abdominal incision length on the gastrointestinal function recovery post-operatively. Background: Gut motility recovers more quickly after the minimally invasive laparoscopic surgery compared than after the traditional open surgery; however, whether the minimal abdominal incision contributes to the faster gut motility recovery is controversial and lacks solid clinical evidence. Methods: A registry-based secondary cohort analysis was conducted to evaluate the association between the abdominal incision length and gut motility recovery post-operatively based on a multicenter, prospective, and observational study of the prolonged post-operative ileus (PPOI) incidence and the risk factors in the patients with the major abdominal surgery. The incision length, in the centimeters, was the exposure. The primary outcome measures were the PPOI incidence and its association with the incision length. The secondary outcome included the days to the first passage of flatus and the days to the first passage of stool. Results: Overall, 1,840 patients, including 287 (15.7%) patients with the PPOI, were recruited. The PPOI incidence was 17.6% and 13.3% in the long-incision (>18 cm) and short-incision patients ( ≤ 18 cm), respectively. The incidence of the PPOI increased by 1.1% (1.0-1.1) by each centimeter increment of the incision length after adjusting for the confounding factors. In comparison to the short-incision patients, the long-incision patients had prolonged passage of stool (4.46 vs. 4.95 days, p < 0.001). Each centimeter increment of the incision length contributed to a 2% increased risk of delay in the first bowel movement [hazard ratio (HR) 0.980 (0.967, 0.994)]. Conclusion: A long abdominal incision length independently contributed to the prolonged gut function recovery post-operatively mainly by delaying the time to the first bowel movement, but not influencing the time to first passage of flatus.

Keywords: colorectal surgery; gastric surgery; incision length; pancreas-duodenum surgery; prolonged post-operative ileus.