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Introduction:
Postoperative ileus (POI) after laparoscopic colorectal surgery leads to increased anxiety for patients and caregivers, and is associated with prolonged hospital stay and increased costs. The aim of this study is to investigate pre-, intra- and postoperative risk factors associated with the development of POI in patients undergoing laparoscopic colorectal surgery.
Patients and Methods:
Patients undergoing laparoscopic colectomy between January 2008 and January 2012 were identified from a prospectively maintained laparoscopic database. Clinical, metabolic and pharmacologic data were obtained retrospectively by reviewing the clinical charts. Patients with rectal resection were excluded. POI was defined as absence of bowel function for 5 or more days, or the need for reinsertion of a nasogastric tube after starting oral diet in the absence of mechanical obstruction. Factors associated with POI were analyzed using Chi-square or Fisher's exact test for categorical variables, Mann-Whitney U test for continuous variables. A multivariate analysis was carried out by logistic regression. P-values <0.05 were considered statistically significant, and Odds Ratios were calculated with a 95% confidence interval.
Results:
Complete data were obtained from a total of 167 patients, with a median age of 50 years (i: 15 - 90), and a slight male predominance (55%). POI was observed in 24/167 patients (14,3%). On univariate analysis, some preoperative factors were significantly related to POI, such as higher age (p= 0,0007), higher ASA status (p=0,003), preoperative diagnose (cancer vs. no cancer; p=0,002), and history of previous abdominal surgery (p=0,019). BMI was not related to POI, neither as continuous variable nor as categorized factor (<30 vs. >=30). Among the intra- and postoperative factors, a longer OR time (p=0,003) as well as a lower postoperative potassium level (p=0,0004) were observed in patients suffering from POI. Neither the amount of intraoperative opioids nor the use of postoperative morphin-based PCA was related to POI. On multivariate analysis, previous abdominal surgery (OR 2,83, CI 1,067 - 7,832), OR time (OR 1,007; CI 1,0011 - 1,0142) and postoperative potassium levels (OR 0,0199; CI 0,064 - 0,6219) showed to be independently associated to POI.
Conclusion:
POI after laparoscopic colectomy is associated with specific preoperative, intraoperative and postoperative factors. Minimizing or addressing these factors may be expected to reduce the incidence of this common complication.