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International Journal of Colorectal Disease

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01-07-2020 | Anemia | Original Article

What are the risk factors of failure of enhanced recovery after right colectomy? Results of a prospective study on 140 consecutive cases

Authors: Clement Destan, Antoine Brouquet, Anne De Carbonnières, Pietro Genova, Christine Fessenmeyer, Jacques De Montblanc, Bruno Costaglioli, Benoit Lambert, Christophe Penna, Stéphane Benoist

Published in: International Journal of Colorectal Disease | Issue 7/2020

Abstract

Purpose

Nausea and vomiting is the main cause of failure of enhanced recovery protocol (ERP) after right hemicolectomy.

Methods

From January 2013 to January 2018, all patients undergoing right hemicolectomy were prospectively included. Patients undergoing emergency surgery, additional complex procedure or temporary stoma, nasogastric tube (NGT) maintenance, or abdominal drainage were excluded. Failure of ERP was defined as nausea/vomiting precluding oral feeding after POD3 and/or the occurrence of postoperative ileus requiring NGT and/or length of stay (LOS) ≥ 8 days except for patients awaiting admission in rehabilitation unit. Risk factors of failure of ERP were identified using univariate and multivariate analysis.

Results

Among 306 patients undergoing right hemicolectomy, 140 fulfilled the inclusion criteria. Postoperative morbidity was 31%, and the mortality rate was nil. The mean postoperative hospital stay was 7 days (range 2–30). Successful ERP was achieved in 83 patients (59%). Causes of failure were major nausea/vomiting precluding oral feeding after POD3 in 36, postoperative ileus requiring NGT in 16 and LOS ≥ 8 days in 36. On multivariate analysis, preoperative anemia (OR 5.2; CI 95%, 1.3–21.1, p = 0.02) and platelet anti-aggregant/anti-coagulant (OR 4.5; CI 95%, 1.7–12.1, p = 0.003) were associated with the risk of failure of ERP.

Conclusion

This study shows that anemia and medication with antiplatelet/anticoagulation therapy increase the risk of failure of ERP after right hemicolectomy that translates most of the time by nausea/vomiting and postoperative ileus. The presence of these factors should lead to adapt the strategy to improve outcome rather than be considered as contraindication to ERP.

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Title: What are the risk factors of failure of enhanced recovery after right colectomy? Results of a prospective study on 140 consecutive cases
Authors: Clement Destan
Antoine Brouquet
Anne De Carbonnières
Pietro Genova
Christine Fessenmeyer
Jacques De Montblanc
Bruno Costaglioli
Benoit Lambert
Christophe Penna
Stéphane Benoist
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Anemia
Nausea
Ileus
Colectomy
Colectomy
Vomiting
Hemicolectomy
Hemicolectomy
Published in: International Journal of Colorectal Disease / Issue 7/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-020-03590-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

What are the risk factors of failure of enhanced recovery after right colectomy? Results of a prospective study on 140 consecutive cases

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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