Risk factors for ileus after enhanced recovery robotic colectomy mediated by postoperative opioids: a single institution analysis.

Abstract

Background: Postoperative ileus (POI) after colorectal surgery is associated with prolonged hospital length of stay, readmission, and higher costs of care. POI may be unpredictable and even uncomplicated enhanced recovery elective minimally invasive colorectal operations may be complicated by ileus and readmission related to ileus. Determining if there are modifiable factors associated with ileus may suggest quality improvement interventions designed to decrease ileus. The aim of this study was to identify patient characteristics associated with ileus and the relationship with postoperative opioids.

Methods: This is a single institution retrospective analysis of robotic right and left colectomy in a prospectively maintained institutional colorectal surgery database from 1/1/2018 to 7/31/2024. The primary outcome was postoperative ileus. Mediation analysis was used to examine the association of patient factors with ileus mediated by postoperative opioids.

Results: There were 394 left and 267 right colectomies that met inclusion criteria. Neoplasia was the operative diagnosis for 89.5% of right colectomies and diverticular disease for 78.7% of left colectomies (p < 0.001). Median postoperative hospital length of stay was 2.0 days. Ileus occurred in 5.6% of the patient population. An analysis with postoperative opioids (intravenous or oral) as mediating variable showed that postoperative opioids were associated with ileus (OR 2.83, CI 1.18-14.67). While older patients had less opioid requirements (OR 0.96, CI 0.95-0.98), the risk of ileus (OR 1.03, CI 1.00-1.06) was the same for older patients with and without opioids. A decrease in opioid prescriptions at discharge was seen over time (p < 0.001).

Conclusion: Postoperative opioids were the only modifiable risk factor for ileus after robotic segmental colectomy. The risk of ileus for other factors associated with ileus did not increase when opioids were added postoperatively. Considering other opioid-sparing enhanced recovery pathway options and increased adoption of the minimally invasive surgical approach may lessen this vexing postoperative complication.