• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • 2022 NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

INCIDENCE AND PREDICTORS OF PROLONGED POST-OPERATIVE ILEUS AFTER COLORECTAL SURGERY IN THE CONTEXT OF AN ENHANCED RECOVERY PATHWAY

Mohsen Alhashemi, MD, MSc, Julio F Fiore Jr, PhD, Nadia Safa, MDCM, Mohammed Al Mahroos, MD, Nicolo Pecorelli, MD, Gabriele Baldini, MD, Nandini Dendukuri, PhD, Barry L Stein, MD, A. Sender Liberman, MD, Patrick Charlebois, MD, Franco Carli, MD, Liane S Feldman, MD. Mcgill University

INTRODUCTION: Prolonged post-operative ileus (PPOI) is a common complication that results in patient discomfort, prolonged length of stay (LOS) and increased costs. Enhanced-recovery pathways (ERPs) are standardized care plans that include interventions to accelerate gastrointestinal (GI) recovery. The incidence and predictors of PPOI have not been widely studied in this context. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery.

METHODS AND PROCEDURES: We analyzed prospectively collected data from an institutional colorectal surgery ERP registry between 2012-2014. Patients with complications predisposing to secondary ileus (bowel obstruction, anastomotic leak, intra-abdominal abscess or bowel perforation) were excluded. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and not passing first flatus or bowel movement on or after post-operative day 4) and compared to other definitions in the literature. Potential risk factors for PPOI were identified from previous studies and their predictive ability was evaluated using Bayesian Model Averaging (BMA), which accounts for model uncertainty by considering all possible models resulting from including or excluding the predictors of interest. Results are presented as posterior effect probability (PEP), which indicates the probability that a particular risk factor is associated with PPOI. The strength of evidence of association was categorized as: no evidence(PEP<50%), weak evidence(50-75%), positive evidence(75-95%), strong evidence(95-99%), and very strong evidence(>99%).

RESULTS: Of the 347 patients, 24 patients with complications that predispose to secondary ileus were excluded, and 323 patients were analyzed (median age 63.5 years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11-59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48hours (PEP 94%; strong evidence), post-operative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3ml/kg/h for laparoscopic and 5ml/kg/hr for open, excluding replacement for blood loss; PEP 55%, weak evidence) were predictors of PPOI.

CONCLUSIONS: The incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably applying different diagnostic criteria, highlighting the need for a consensus definition. The use of intravenous opioids is a modifiable strong predictor of PPOI within an ERP, while the role of epidural analgesia and intraoperative fluid management should be further evaluated in larger studies.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87795

Program Number: S131

Presentation Session: ERAS Session

Presentation Type: Podium

19

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2018 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons