2005 Abstracts: Prolonged Postoperative Ileus: Definition, Risk Factors and Predictors in Patients Undergoing Open Colorectal Surgery
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Prolonged Postoperative Ileus: Definition, Risk Factors and Predictors in Patients Undergoing Open Colorectal Surgery
Avo Artinyan, Joseph W. Nunoo-Mensah, Rahila Essani, Swarna Balasubramaniam, Jim Gauderman, Claudia Gonzalez-Ruiz, Petar Vukasin, Andreas M. Kaiser, Robert W. Beart, University of Southern California, Los Angeles, CA
Background: Post-operative ileus remains an inevitable consequence of abdominal surgery. Though the pathogenesis of delayed gastrointestinal transit in the post-operative period has been a subject of considerable study, a clinically useful definition of what constitutes a pathologically prolonged ileus has yet to be established. The objectives of this study were to describe a clinically useful definition for an abnormally prolonged ileus and to identify risk factors and predictors of prolonged ileus in patients undergoing colorectal surgery.
Methods: The medical records of 88 patients were reviewed for demographic data, primary diagnosis, previous surgical history, preoperative medications, total post-operative narcotic use, estimated blood loss (EBL), anesthetic and surgical time. The effects of these factors on the duration of post-operative ileus were examined using non-parametric statistical comparison tests, standard univariate and multiple regression techniques. The duration of post-operative ileus was defined as the number of days between surgery and the patient's ability to tolerate a solid diet in the absence of nausea, vomiting or abdominal distention. Results: The mean number of days to initialization unrestricted clear fluids was 2.3 ± 0.17 days (median 2.0). The mean duration of post-operative ileus was 5.4 ± 0.3 days (median 5.0) with 61 (69%) patients tolerating a regular diet by the 5th post-operative day and 85 (97%) patients by the 10th post-operative day. In 4 patients who had an ileus, additional surgical or endoscopic intervention was required to resolve their problem. Univariate regression demonstrated statistically significant positive correlations between EBL, total surgery time, and total post-operative narcotic dose (p=0.019, p=0.045 and p=0.041 respectively). Multiple regression analysis identified EBL and total narcotic dose as independent predictors of duration of post-operative ileus. Discussion: We have identified two risk factors (EBL and total post-operative narcotic dose) that are associated with prolonged postoperative ileus. The near ubiquitous use of opioids in the postoperative setting identifies a potential point of intervention to shorten the duration of postoperative ileus. Our data also demonstrates that following colorectal surgery, an ileus greater than 5 days serves as a better indicator of prolonged ileus than the 3 days which has been reported in previous publications.
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