|
|
Back to 2017 Posters
METOCLOPRAMIDE AFTER COLORECTAL RESECTION ENHANCES GASTROINTESTINAL RECOVERY AND REDUCES LENGTH OF STAY
Ahmed M. Al-Mazrou*, Sabrina Toledano, Neda Valizadeh, Kunal Suradkar, Benjamin Kuritzkes, Laura Hyde, Jessica Rein, Ravi P. Kiran
Division of Colorectal Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
Background: Delayed gastrointestinal recovery leads to significant resource utilization after colorectal surgery. Metoclopramide reduces nausea and emesis, and enhances gastrointestinal motility postoperatively. Whether its routine use after colorectal resection enhances gastrointestinal recovery has not been characterized.
Methods: The routine use of scheduled Metoclopramide (10 mg) every 8 hours beginning after surgery and until return of bowel function was introduced into a single colorectal center to reduce nausea and vomiting and impact ileus in November 2013. Choice of a particular surgeon determined the routine use or otherwise of Metoclopramide. From a prospective outcomes database, patients who underwent elective partial colorectal resection with primary anastomosis without fecal diversion from November 2013 - October 2016 were identified. Patients who received Metoclopramide (10 mg) within 24 hours postoperatively and continued to have routine doses, were compared to others for demographics, co-morbidities, diagnosis, type of surgery and approach. Time to first flatus and bowel movement, development of nausea, vomiting or ileus, postoperative complications and length of stay were the primary outcomes.
Results: Of 427 patients, 140 (32.8%) received Metoclopramide, with an average of 13.7 doses. Demographics and pre-existing co-morbidities were similar, except for fewer male and hypertensive patients in the Metoclopramide group. Primary diagnosis, ASA, wound class, type of surgery and approach as well as conversion rates were similar. Routine scheduled Metoclopramide was associated with earlier return of gastrointestinal function (median day [IQR], flatus: 2 [1] vs. 3 [2], p=<0.0001, bowel movement: 3 [1] vs. 4 [2], p=<0.0001). Nausea, vomiting, postoperative ileus and length of stay were also lower with Metoclopramide but did not reach statistical significance. Postoperative complications rates were similar.
Conclusion: These preliminary data suggest that the routine administration of Metoclopramide within 24 hours after colorectal resection potentially accelerates gastrointestinal function and speeds recovery without adversely influencing complications.
Patients characteristics, operative features and postoperative outcomes
| Variable |
Metoclopramide
N= 140
|
No Metoclopramide
N= 287
| p-value | Age
≤ 64 years
≥ 65 years
| 77 (55%)
63 (45%)
| 147 (51.2%)
140 (48.8%)
| 0.5 | Gender
Male
Female
| 55 (39.3%)
85 (60.7%)
|
153 (53.3%)
134 (46.7%)
| 0.01 | | Race (white) | 90 (64.3%) | 176 (61.3%) | 0.7 | ASA classification
I
II
III
IV
Unknown
| 3 (2.1%)
81 (57.9%)
51 (36.4%)
3 (2.1%)
2 (1.4%)
| 8 (2.8%)
146 (50.9%)
121 (42.2%)
9 (3.1%)
3 (1%)
| 0.7 | Wound classification
I
II
III
IV
Unknown
| 1 (0.7%)
82 (58.6%)
42 (30%)
12 (8.6%)
3 (2.1%)
| 1 (0.3%)
168 (58.5%)
92 (32.1%)
21 (7.3%)
5 (1.7%)
| 1.0 | Primary diagnosis
Cancer
Diverticular disease
Inflammatory bowel disease
Other
| 73 (52.1%)
39 (27.9%)
8 (5.7%)
20 (14.3%)
| 162 (56.4%)
57 (19.9%)
10 (3.5%)
58 (20.2%)
| 0.1 | Resection type
Partial colectomy
Partial proctectomy
| 104 (74.3%)
36 (25.7%)
| 228 (79.4%)
59 (20.6%)
| 0.2 |
Surgical approach
Open surgery
Minimally invasive surgery
| 16 (11.4%)
124 (88.6%)
| 41 (14.3%)
246 (85.7%)
| 0.4 | | Conversion to open surgery | 18 (14.6%) | 43 (17.8%) | 0.4 | | Estimated blood loss (ml), mean | 110.2 (153.4) | 115.5 (185.4) | 0.8 | Postop day of first flatus,
median (IQR)
mean (SD)
| 2 (1)
2.9 (2.4)
| 3 (2)
3.4 (1.7)
| <0.0001
0.1
| Postop day of first bowel movement, median (IQR)
mean (SD)
| 3 (1)
3 (2.3)
| 4 (2)
3.8 (1.9)
| <0.0001
0.002
| | Length of stay, mean (SD) | 4.6 (2.7) | 4.8 (3.2) | 0.7 | | Postoperative nausea | 39 (27.9%) | 91 (31.7%) | 0.4 | | Postoperative vomiting | 18 (12.9%) | 53 (18.5%) | 0.1 | | Postoperative ileus | 14 (10%) | 34 (11.8%) | 0.6 | | Surgical site infection | 8 (5.7%) | 17 (5.9%) | 0.9 | | Bowel leak | 2 (1.4%) | 5 (1.7%) | 0.8 | | Intra-abdominal or pelvic abscess | 2 (1.4%) | 4 (1.4%) | 1.0 | | Reoperation | 1 (0.7%) | 9 (3.1%) | 0.1 | | Pneumonia | 0 (0) | 6 (2.1%) | 0.1 | | Dehydration | 2 (1.4%) | 3 (1%) | 0.7 | | Renal failure | 0 (0) | 3 (1%) | 0.2 | | Urinary tract infection | 1 (0.7%) | 5 (1.7%) | 0.4 | | Readmission | 8 (5.7%) | 21 (7.3%) | 0.5 |
Data illustrated by frequency (n) and percentage (%) unless indicated otherwise.
Back to 2017 Posters
|
