Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 6/2017

01-06-2017 | Original Article

Preoperative risk factors for prolonged postoperative ileus after colorectal resection

Authors: Albert M. Wolthuis, Gabriele Bislenghi, Maarten Lambrecht, Steffen Fieuws, Anthony de Buck van Overstraeten, Guy Boeckxstaens, André D’Hoore

Published in: International Journal of Colorectal Disease | Issue 6/2017

Login to get access

Abstract

Purpose

Prolonged postoperative ileus (PPOI) after colorectal resection significantly impacts patients’ recovery and hospital stay. Because treatment options for PPOI are limited, it is necessary to focus on prevention strategies. The aim of this study is to investigate risk factors associated with PPOI in patients undergoing colorectal surgery.

Methods

Data from all consecutive patients who underwent colorectal resection in our department were retrospectively analyzed from a prospective database over a 9-month period. PPOI was defined as the necessity to insert a nasogastric tube in a patient who experienced nausea and two episodes of vomiting with absence of bowel function. Multivariable analysis was performed considering a prespecified list of 16 potential preoperative risk factors.

Results

A total of 523 patients (mean age 59 years; 52.2% males) were included, and 83 patients (15.9%) developed PPOI. Statistically significant independent predictors of PPOI were male sex (OR 2.07; P = 0.0034), open resection (OR 4.47; P < 0.0001), conversion to laparotomy (OR 4.83; P = 0.0015), splenic flexure mobilization (OR 1.72; P = 0.063), and rectal resection (OR 2.72; P = 0.0047). Discriminative ability of this prediction model was 0.72.

Conclusions

Therapeutic strategies aimed to prevent PPOI after colorectal resection should focus on patients with increased risk. Patients and medical staff can be informed of the higher PPOI risk, so that early treatment can be started.
Literature
1.
2.
3.
4.
Delaney CKH, Senagore A et al (2006) Clinical consensus update in general surgery, postoperative ileus: profiles, risk factors, and definitions—a framework for optimizing surgical outcomes in patients undergoing major abdominal and colorectal surgery. Clinical Consensus Update in General Surgery (consensus statement)
5.
Wolthuis AM, Bislenghi G, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G, D'Hoore A (2015) Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. doi:10.​1111/​codi.​13210
6.
Iyer S, Saunders WB, Stemkowski S (2009) Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm 15(6):485–494PubMed
7.
Kronberg U, Kiran RP, Soliman MSM, Hammel JP, Galway U, Coffey JC, Fazio VW (2011) A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg 253(1):78–81CrossRefPubMed
8.
Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA, Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care Study G, Enhanced Recovery after Surgery G (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93(7):800–809. doi:10.​1002/​bjs.​5384 CrossRefPubMed
9.
Chapuis PH, Bokey L, Keshava A, Rickard MJFX, Stewart P, Young CJ, Dent OF (2013) Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg 257(5):909–915CrossRefPubMed
10.
Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E (2012) Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg 36(1):179–185CrossRefPubMed
11.
Artinyan A, Nunoo-Mensah JW, Balasubramaniam S, Gauderman J, Essani R, Gonzalez-Ruiz C, Kaiser AM, Beart RW Jr (2008) Prolonged postoperative ileus—definition, risk factors, and predictors after surgery. World J Surg 32(7):1495–1500CrossRefPubMed
12.
Vather R, Bissett IP (2013) Risk factors for the development of prolonged post-operative ileus following elective colorectal surgery. Int J Color Dis 28(10):1385–1391CrossRef
13.
Vather R, Josephson R, Jaung R, Robertson J, Bissett I (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157(4):764–773. doi:10.​1016/​j.​surg.​2014.​12.​005 CrossRefPubMed
14.
15.
16.
Chang GJ (2006) Laparoscopic treatment of colorectal neoplasia. Current Treatment Options in Gastroenterology 9(3):256–264CrossRefPubMed
17.
Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, Van Wagensveld BA, Van Der Zaag ES, Van Geloven AAW, Sprangers MAG, Cuesta MA, Bemelman WA (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254(6):868–875CrossRefPubMed
18.
Bauer AJ, Boeckxstaens GE (2004) Mechanisms of postoperative ileus. Neurogastroenterol Motil 16(SUPPL. 2):54–60CrossRefPubMed
19.
Kalff JC, Schraut WH, Simmons RL, Bauer AJ (1998) Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 228(5):652–663CrossRefPubMedPubMedCentral
20.
Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, Watkins LR, Wang H, Abumrad N, Eaton JW, Tracey KJ (2000) Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature 405(6785):458–462. doi:10.​1038/​35013070 CrossRefPubMed
21.
22.
de Jonge WJ, van der Zanden EP, The FO, Bijlsma MF, van Westerloo DJ, Bennink RJ, Berthoud HR, Uematsu S, Akira S, van den Wijngaard RM, Boeckxstaens GE (2005) Stimulation of the vagus nerve attenuates macrophage activation by activating the Jak2-STAT3 signaling pathway. Nat Immunol 6(8):844–851. doi:10.​1038/​ni1229 CrossRefPubMed
23.
24.
Vasquez W, Hernandez AV, Garcia-Sabrido JL (2009) Is gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis of randomized clinical trials. J Gastrointest Surg 13(4):649–656CrossRefPubMed
25.
de Castro SM, van den Esschert JW, van Heek NT, Dalhuisen S, Koelemay MJ, Busch OR, Gouma DJ (2008) A systematic review of the efficacy of gum chewing for the amelioration of postoperative ileus. Dig Surg 25(1):39–45. doi:10.​1159/​000117822 CrossRefPubMed
26.
Noble EJ, Harris R, Hosie KB, Thomas S, Lewis SJ (2009) Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg 7(2):100–105CrossRefPubMed
27.
van den Heijkant TC, Costes LM, van der Lee DG, Aerts B, Osinga-de Jong M, Rutten HR, Hulsewe KW, de Jonge WJ, Buurman WA, Luyer MD (2015) Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery. Br J Surg 102(3):202–211. doi:10.​1002/​bjs.​9691 CrossRefPubMed
28.
29.
Wang H, Yu M, Ochani M, Amella CA, Tanovic M, Susarla S, Li JH, Wang H, Yang H, Ulloa L, Al-Abed Y, Czura CJ, Tracey KJ (2003) Nicotinic acetylcholine receptor alpha7 subunit is an essential regulator of inflammation. Nature 421(6921):384–388. doi:10.​1038/​nature01339 CrossRefPubMed
30.
Petros JG, Realica R, Ahmad S, Rimm EB, Robillard RJ (1995) Patient-controlled analgesia and prolonged ileus after uncomplicated colectomy. Am J Surg 170(4):371–374CrossRefPubMed
31.
Schang JC, Hemond M, Hebert M, Pilote M (1986) How does morphine work on colonic motility? An electromyographic study in the human left and sigmoid colon. Life Sci 38(8):671–676CrossRefPubMed
32.
Thorn SE, Wattwil M, Lindberg G, Sawe J (1996) Systemic and central effects of morphine on gastroduodenal motility. Acta Anaesthesiol Scand 40(2):177–186CrossRefPubMed
33.
Ahn H, Bronge A, Johansson K, Ygge H, Lindhagen J (1988) Effect of continuous postoperative epidural analgesia on intestinal motility. Br J Surg 75(12):1176–1178CrossRefPubMed
34.
Carli F, Trudel JL, Belliveau P (2001) The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Dis Colon rectum 44(8):1083–1089
35.
36.
Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, Feinglass NG, Metzger PP, Fulmer JT, Smith SL (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 83(4):757–765CrossRefPubMed
37.
Steinberg RB, Liu SS, Wu CL, Mackey DC, Grass JA, Ahlen K, Jeppsson L (2002) Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and recovery after open colon surgery. J Clin Anesth 14(8):571–577CrossRefPubMed
38.
Marret E, Remy C, Bonnet F, Breivik H, Curatolo M, Gomar C, Le Bars M, Popping D, Tramer M (2007) Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 94(6):665–673CrossRefPubMed
39.
40.
daSilva M, Lomelin D, Tsui J, Klinginsmith M, Tadaki C, Langenfeld S (2015) Pain control for laparoscopic colectomy: an analysis of the incidence and utility of epidural analgesia compared to conventional analgesia. Tech Coloproctol 19(9):515–520. doi:10.​1007/​s10151-015-1336-z CrossRefPubMed
Metadata
Title
Preoperative risk factors for prolonged postoperative ileus after colorectal resection
Authors
Albert M. Wolthuis
Gabriele Bislenghi
Maarten Lambrecht
Steffen Fieuws
Anthony de Buck van Overstraeten
Guy Boeckxstaens
André D’Hoore
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 6/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-017-2824-6

Other articles of this Issue 6/2017

International Journal of Colorectal Disease 6/2017 Go to the issue

Original Article

Prognosis of video-assisted thoracoscopic pulmonary metastasectomy in patients with colorectal cancer lung metastases: an analysis of 154 cases

Original Article

Impact of postoperative complications on readmission and long-term survival in patients following surgery for colorectal cancer

Rapid Communication

Sacral nerve stimulation for faecal incontinence in patients with sacral malformation

Original Article

Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy?

Original Article

Endoscopic ultrasonography and computed tomography scanning for preoperative staging of colonic cancer

Original Article

Proposal of a new classification of postoperative ileus based on its clinical impact—results of a global survey and preliminary evaluation in colorectal surgery