Predictive factors for postoperative ileus after elective right hemicolectomy performed on over 80% Enhanced Recovery After Surgery-adherent patients: a retrospective cohort study.

IF 1.2 4区医学 Q3 SURGERY

Annals of Surgical Treatment and Research Pub Date : 2024-08-26 DOI:10.4174/astr.2024.107.3.158

Mohamud Aden,Tom Scheinin,Shamel Ismail,Antti J Kivelä,Suvi Rasilainen

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Abstract

Purpose Laparoscopic right hemicolectomy is the standard surgical approach for treatment of right-sided colonic neoplasms. Although performed within a strict Enhanced Recovery After Surgery (ERAS) program, patients still develop postoperative ileus. The aim of this study was to describe the factors responsible for postoperative ileus after right hemicolectomy in a patient population with over 80% ERAS adherence. Methods In this retrospective study, we analyzed 499 consecutive patients undergoing elective right-sided colectomy for neoplastic disease in a single high-volume center. All patients followed an updated ERAS program. Results The overall median ERAS adherence was 80%. Patients with ≥ 80% adherence (n = 271) were included in further analysis. Their median ERAS adherence was 88.9% (interquartile range, 80-90; range, 80-100). Twenty-four of 271 patients (8.9%) developed postoperative ileus. A univariate regression analysis revealed carcinoma situated in the transverse colon, duration of operation over 200 minutes, and opiate consumption over 10 mg on the second postoperative day (POD) to be associated with a significantly higher risk of postoperative ileus. Multivariate regression analysis revealed that duration of surgery over 200 minutes (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0-5.8; P = 0.045) and opiate consumption over 10 mg on POD 2 (OR, 4.8; 95% CI, 1.6-14.3; P = 0.005) independently predict a higher risk for postoperative ileus. The median length of hospital stay was significantly longer in patients with postoperative ileus (8 days vs. 3 days, P < 0.001). None of the 271 patients died during a 30-day follow-up. Conclusion Long duration of surgery, even minor postoperative opiate use, predict a higher risk for postoperative ileus in strictly ERAS-adherent patients undergoing laparoscopic right hemicolectomy.

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一项回顾性队列研究：对 80% 以上坚持 "术后加强康复 "的患者实施择期右半结肠切除术后出现术后回肠梗阻的预测因素。

目的腹腔镜右半结肠切除术是治疗右侧结肠肿瘤的标准手术方法。尽管手术是在严格的术后恢复（ERAS）计划下进行的，但患者仍会出现术后回肠梗阻。本研究的目的是描述在ERAS遵守率超过80%的患者群体中，导致右半结肠切除术后回肠淤血的因素。方法在这项回顾性研究中，我们分析了在一个高产量中心接受肿瘤性疾病右侧结肠切除术的499名连续患者。所有患者都遵守了最新的ERAS计划。结果ERAS遵守率的总体中位数为80%。坚持率≥80%的患者（n = 271）被纳入进一步分析。他们的ERAS坚持率中位数为88.9%（四分位间范围为80-90；范围为80-100）。271 例患者中有 24 例（8.9%）出现术后回肠梗阻。单变量回归分析表明，横结肠癌、手术时间超过 200 分钟以及术后第二天（POD）服用阿片类药物超过 10 毫克与术后回肠梗阻的风险显著增加有关。多变量回归分析表明，手术时间超过 200 分钟（几率比 [OR]，2.4；95% 置信区间 [CI]，1.0-5.8；P = 0.045）和术后第 2 天服用阿片类药物超过 10 毫克（OR，4.8；95% 置信区间 [CI]，1.6-14.3；P = 0.005）可独立预测较高的术后回肠梗阻风险。术后回肠梗阻患者的中位住院时间明显更长（8 天 vs. 3 天，P < 0.001）。结论在严格遵守ERAS的腹腔镜右半结肠切除术患者中，手术时间长，甚至术后轻微使用阿片类药物都会增加术后回肠梗阻的风险。

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来源期刊

Annals of Surgical Treatment and Research SURGERY-

CiteScore

2.30

自引率

7.10%

发文量

期刊介绍： Manuscripts to the Annals of Surgical Treatment and Research (Ann Surg Treat Res) should be written in English according to the instructions for authors. If the details are not described below, the style should follow the Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publications available at International Committee of Medical Journal Editors (ICMJE) website (http://www.icmje.org).