Nourah Alsharqawi, MBBS, MSc, Mohsen Alhashemi, MD, MSc, Pepa Kaneva, MSc, Gabriele Baldini, MD, Julio Fiore Jr, PhD, Liane Feldman, MD, Lawrence Lee, MD, PhD. McGill University
Background: Postoperative ileus(POI) is common after gastrointestinal surgery and is associated with significant morbidity and costs. However, POI is poorly defined. The I-FEED score is a novel outcome measure for POI, developed by expert consensus. It contains five elements(intake, response to nausea treatment, emesis, exam, and duration, each scored with 0, 1, or 3 points)and classifies patients into normal, postoperative gastrointestinal intolerance(POGI), and postoperative gastrointestinal dysfunction(POGD). However, it has not yet been validated in a clinical context. The objective was to provide validity evidence for the I-FEED score to measure the construct of POI in patients undergoing colorectal surgery.
Methods: Data previously collected from a clinical trial investigating perioperative management strategies in patients undergoing elective laparoscopic colectomy(2013-2015) were analyzed. Patients were managed by a longstanding Enhanced Recovery program (expected length of stay(LOS): 3 days). Daily I-FEED scores were generated (normal 0-2, POGI 3-5, POGD 6+ points) up to hospital discharge or postoperative day 7. Validity was assessed by testing the hypotheses that I-FEED score was higher (1) in patients with longer time to GI3(tolerating diet + flatus/bowel movement), (2) with longer LOS(>3 days vs shorter), (3) in patients with complications vs without, (4) in patients with poorer recovery(measured by Quality-of-Recovery 9 questionnaire).The value of the I-FEED score to predict a prolonged hospitalization was also investigated.
Results: A total of 128 patients were included for analysis (mean age 61.8 years (SD15.3), 57.5% male, 71.1% malignancy, and 39.1% rectal resection). Median LOS was 4 days [IQR3-5], and 32.3% experienced postoperative morbidity. Overall, 48.1% of patients were categorized as normal, 21.7% POGI, and 30.2% POGD.The data supported all 4 hypotheses(Table 1). Patients with LOS <3days had a lower I-FEED score on postoperative day 2 than those with LOS >3days(1.6 points(SD1.9) vs. 3.5 points(SD3.4), p<0.001).
Conclusions: Preliminary validity evidence for the I-FEED score as a measure for POI was provided. This score may have utility as both an outcome measure and as a predictor for a complicated clinical course.
| Normal(0-2 points,n=61 | POGI(3-5 points,n=28) | POGD(6+ points,n=39) | p | |
|---|---|---|---|---|
| Median LOS,days[IQR] | 3[3-4] | 3[3-4] | 7[4-11] | <0.001 |
| Mean time to GI3,days(SD) | 1.1(0.5) | 1.4(0.6) | 2.1(2.1) | <0.001 |
| Complications,% | 16.1% | 14.3% | 73.0% | <0.001 |
| Mean Quality-of-Recovery-9 on POD2,points(SD) | 15.2(2.3) | 13.9(2.2) | 12.8(2.7) | <0.001 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94688
Program Number: S071
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel