A snapshot of intraoperative conditions to predict prolonged postoperative ileus after colorectal surgery
Duveke P. E. de Gaay Fortman BSc
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Faculty of Medical Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Contribution: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Writing - original draft
Search for more papers by this authorCorresponding Author
Hidde M. Kroon MD, PhD
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Correspondence
A/Prof. Hidde M. Kroon, Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia.
Email: [email protected]@hiddekroon
Contribution: Conceptualization, Formal analysis, Project administration, Supervision, Validation, Writing - original draft
Search for more papers by this authorSergei Bedrikovetski BHSc (Hons)
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Data curation, Methodology, Software, Validation, Writing - review & editing
Search for more papers by this authorTracy R. Fitzsimmons BHealthSc (Hons), PhD
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Data curation, Supervision, Writing - review & editing
Search for more papers by this authorNagendra N. Dudi-Venkata MBBS, GDipSurgicalEd
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorTarik Sammour MBChB, FRACS, PhD
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Formal analysis, Supervision, Validation, Writing - review & editing
Search for more papers by this authorDuveke P. E. de Gaay Fortman BSc
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Faculty of Medical Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Contribution: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Writing - original draft
Search for more papers by this authorCorresponding Author
Hidde M. Kroon MD, PhD
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Correspondence
A/Prof. Hidde M. Kroon, Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia.
Email: [email protected]@hiddekroon
Contribution: Conceptualization, Formal analysis, Project administration, Supervision, Validation, Writing - original draft
Search for more papers by this authorSergei Bedrikovetski BHSc (Hons)
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Data curation, Methodology, Software, Validation, Writing - review & editing
Search for more papers by this authorTracy R. Fitzsimmons BHealthSc (Hons), PhD
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Data curation, Supervision, Writing - review & editing
Search for more papers by this authorNagendra N. Dudi-Venkata MBBS, GDipSurgicalEd
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorTarik Sammour MBChB, FRACS, PhD
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Contribution: Formal analysis, Supervision, Validation, Writing - review & editing
Search for more papers by this authorAbstract
Background
The cause of prolonged postoperative ileus (PPOI) is multifactorial. The influence of preoperative factors on PPOI has been well documented, but little is known about the impact of intraoperative conditions. The aim of this study was to investigate the influence of intraoperative factors on PPOI in patients undergoing colorectal surgery.
Methods
The LekCheck study database of the Colorectal Unit at the Royal Adelaide Hospital was analysed. Per patient, over 60 data points were prospectively collected between March 2018 and July 2020. Intraoperative data were collected in theatre during a one-off snapshot measure. Univariate and multivariable logistic regression analyses were performed.
Results
Data of 336 patients were included. The median age was 66 years and 58.3% were male. Ninety-three patients (27.7%) developed PPOI. Univariate analysis identified the following intraoperative variables as risk-factors of PPOI: greater volumes of intraoperative IV fluid administration (464 versus 415 mL/h for those without PPOI; p = 0.04), side-to-side anastomosis orientation (53.8 versus 41.2%; p = 0.04) and increased perioperative opioid use (6.73 versus 4.11 mg/kg morphine equivalents for patients with and without PPOI, respectively; p = 0.02). Upon multivariable analysis, increased perioperative opioid use remained significant (p = 0.05), as well as the preoperative factors anticoagulation use (p = 0.04) and higher levels of serum total protein (p = 0.02).
Conclusion
This study suggests that intraoperative factors may also contribute to the development of PPOI, but this could not be confirmed in the multivariate analysis. Further studies including larger patient numbers will be required to determine the impact of intraoperative conditions on the development of PPOI.
Conflict of interest
None declared.
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