M. Murphy4, S. Tevis4, G. Kennedy4 4University Of Wisconsin,School of Medicine And Public Health, Department Of Surgery,Madison, WI, USA
Introduction: Postoperative ileus has a significant impact on patient wellbeing, and with a 15% incidence in colectomy patients, costs US hospitals more than 750 million dollars a year. While some causative mechanisms have been identified, little is known about what places patients at risk for ileus. We sought to characterize preoperative and intraoperative predictors of ileus in colectomy patients.
Methods: Patients who underwent elective surgery between 2011-2012 were identified from the colectomy-specific ACS-NSQIP database. We performed descriptive statistics and evaluated demographics, comorbidities, health indicators, preoperative treatments, and operative characteristics as independent risk factors for ileus using multivariate analyses. All analyses were performed with SPSS version 22. A p-value < 0.05 was considered significant for the purposes of this study.
Results: We included 9734 patients in this analysis. Of the patients in this study, 1364 (14%) were found to have a postoperative ileus. Patients who developed an ileus were more likely to develop any postoperative complication (26.4% v 9.9%, p < 0.001). In addition, patients who suffer post-operative ileus are significantly more likely to be readmitted (20% vs 13%, p < 0.001) and more likely to require reoperation (37% vs 13%, p < 0.001) compared with patients without ileus. Independent risk factors for ileus included demographic and preoperative factors including older patient age (OR 1.95, 95% CI 1.58-2.42), male gender (OR 1.41, 95% CI 1.24-1.60), obesity (OR 1.32, 95% CI 1.12-1.56), preoperative chemotherapy (OR 1.53, 95% CI 1.21-1.94), preoperative ascites (OR 1.86, 95% CI 1.07-3.22), preoperative sepsis (OR 1.74, 95% CI 1.32-2.29), and smoking (OR 1.20, 95% CI 1.02-1.41). Intraoperative and perioperative factors included lack of oral antibiotics (OR 1.29, 95% CI 1.10-1.50), lack of mechanical bowel preparation (OR 1.15, 95% CI 1.01-1.32), open approach (OR 2.04, 95% CI 1.77-2.36), and long operation times (OR 1.63, 95% CI 1.36-1.96).
Conclusion: We identified a number of modifiable risk factors for development of ileus including smoking, weight loss, preoperative oral antibiotics, mechanical bowel preparation, and surgical approach. Preoperative modification of risk factors for ileus may not only improve patients’ quality of life, but may also influence outcomes such as postoperative complications, readmission, and reoperation.