Richard Garfinkle, MD, Faisal Al-Rashid, MD, Nancy Morin, MD, Carol-Ann Vasilevsky, MD, Gabriela Ghitulescu, MD, Julio Faria, MD, Marylise Boutros, MD. Jewish General Hospital, Montreal, QC, Canada
Introduction: Primary postoperative ileus (pPOI) is the most common gastrointestinal complication following colonic resection. The objective of this study was to determine whether right-sided colectomies (RC) were associated with a higher incidence of pPOI compared to left-sided colectomies (LC).
Methods and Procedures: Adult patients who underwent elective colectomy for neoplastic disease between 2012-2016 were retrospectively identified using the American College of Surgeons National Surgical Quality Improvement Program database. RC and LC were defined as having an ileocolic or colocolic/colorectal anastomosis, respectively. Coarsened Exact Matching (CEM) was used to balance the two groups (1:1) on the following nine a priori selected confounders: age, sex, body mass index, American Society of Anaesthesiologists score, preoperative albumin, bowel preparation, operative approach, operative time, and perioperative transfusions. The association between type of colectomy and pPOI, defined as POI in the absence of intra-abdominal sepsis, was then assessed in a multiple logistic regression analysis of the matched data, accounting for any residual imbalance. Secondary outcomes (NSQIP-defined major morbidity, length of stay, 30-day readmissions, and 30-day mortality) were assessed by multiple logistic and quantile regression, respectively.
Results: Of 40,636 patients who underwent a colectomy for neoplastic disease, 15,231 underwent a RC and 25,405 a LC. There were several important differences on univariate analysis of the unmatched data. After CEM, 12,949 matched patients remained in each group, and all important confounders were well balanced. The incidence of pPOI was higher in the RC group (11.5% vs. 8.8%, p<0.001). On multiple logistic regression, RC was associated with a 35% higher odds of developing pPOI compared to LC (OR 1.35, 95% CI 1.25-1.47). RC was also associated with increased risk for NSQIP-defined major morbidity (OR 1.10, 95% CI 1.01-1.20), 30-day readmission (OR 1.16, 95% CI 1.06-1.27), and increased length of stay (β=0.16 days, 95% CI 0.11-0.22), but not increased risk for 30-day mortality (OR 0.99, 95% CI 0.76-1.28).
Conclusion(s): pPOI is more common after RC than LC. Given the high prevalence of RC for neoplastic disease, future research should aim at better understanding the pathophysiology behind this increased risk and identifying interventions to mitigate pPOI in this population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95301
Program Number: P363
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster