MALE GENDER, OSTOMY, INFECTION, AND IV FLUIDS ARE ASSOCIATED WITH INCREASED RISK OF POST-OPERATIVE ILEUS IN ELECTIVE COLORECTAL PATIENTS
Kelsey Koch*1, Alexander Hart2, Amanda Kahl2, Mary Charlton2, Muneera Kapadia1, Jennifer Hrabe1, Imran Hassan1, John Cromwell1, Irena Gribovskaja-Rupp1
1Surgery, University of Iowa, Iowa City, IA; 2School of Public Health, University of Iowa, Iowa City, IA
Introduction:
Post-operative ileus (POI) is a common complication after elective colorectal surgery with significant morbidity and financial burden with rates as high as 12-30%. Financial costs of post-operative ileus can reach $750 million annually. Certain factors are protective, such as enhanced recovery protocols (ERAS). The purpose of this study is to investigate risk factors associated with POI after elective colorectal surgery under an ERAS protocol.
Methods:
All elective colorectal cases performed at our institution between 1/2015 and 3/2018 were analyzed retrospectively in NSQIP database format and additional variables of interest added. All cases were performed at a tertiary care academic center by colorectal surgeons using a standardized ERAS protocol. Sociodemographics, indication, approach, type of immediate enteric outlet (anastomosis vs. ostomy), co-morbidities, complications, preoperative benzodiazepine/opioid use, IV lidocaine use, and amount of IV fluids received were recorded. POI was defined as inability to tolerate oral intake or presence of nasogastric tube at 3 days postoperatively. Multivariate logistic regression analysis was performed to determine association with POI among the data points studied. This study was approved by the Institutional Review Board at University of Iowa Hospitals and Clinics.
Results:
A total of 464 cases were analyzed; 222 (48%) were male and average age was 58 (±15.3). Overall rate of POI was 18.5%. Females had significantly lower odds of POI (OR 0.49, 95%CI 0.281-0.849). Patients who had an ileostomy, colostomy, or ileorectal anastomosis had greater odds of POI when compared to colorectal/colonic anastomosis (OR 4.48, 95%CI 2.192-9.136). Those who had an infection, whether superficial, deep, or organ space, had greater odds of POI as compared to those without any infection (OR 3.56, 95%CI 1.769-7.177). Patients who received ≥4000 mL of IVF within the first 72 hours (including intraoperative) had a much higher chance of POI as compared to those who received <2000 mL (OR 6.67, 95%CI 1.006-7.371). There was no significant difference in rates of POI in patients who received IV lidocaine intraoperatively or who were taking preoperative benzodiazepines or narcotics.
Discussion:
POI is significantly associated with amount of IVF within 72 hours of surgery, patient gender, and presence of an ostomy or ileorectal anastomosis. Appropriate preoperative education of patients and perioperative management of these risk factors may help reduce POI.
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