Key result
Open approach and omitting oral antibiotics linked to a ~13% incidence of postoperative ileus.
Cohort (n=29,201)
Yes
A nomogram based on nationwide data can predict the risk of postoperative ileus after elective colectomy with moderate accuracy (C-index 0.69).
May aid POI risk stratification after colectomy; leaves open external validation before clinical adoption.
Postoperative ileus (POI) is a clinical burden to health-care system. This study aims to evaluate the incidence and predictors of POI in patients undergoing colectomy and create a nomogram by using recently released procedure-targeted nationwide database. Patients who underwent elective colectomy in 2012 and 2013 were identified from American College of Surgeons National Surgical Quality Improvement Program using the new procedure-targeted database. Demographics, comorbidities, and 30-day postoperative outcomes were evaluated. Variables in the final stepwise multiple logistic regression model for each outcome were selected in a stepwise fashion using Akaike's information criterion. A nomogram was created to aid in the calculation of POI risk for individual patients. A total of 29,201 patients met the inclusion criteria; 3834 (13.1%) developed POI with a male predominance (55.9%). Patients who developed ileus had longer length of hospital stay (11 vs 5 days; P < 0.001) and operative time (200 vs 174 minutes; P < 0.001). In the stepwise logistic regression model, the following variables were found to be independent risk factors for POI: older age (P < 0.001), male gender (P < 0.001), American Society of Anesthesiologists class III/IV (P < 0.001), open approach (P < 0.001), preoperative septic conditions (P < 0.001), omission of oral antibiotic before surgery (P < 0.001), right colectomy or total colectomy vs other procedures (P < 0.001), smoking (P = 0.001), decreased preoperative serum albumin level (P < 0.001), and prolonged operating time (P < 0.001). All postoperative complications were more frequently occurred in patients with POI. The nomogram accurately predicted POI with a concordant index for this model of 0.69. The use of minimal invasive techniques, control of preoperative septic conditions, oral antibiotic bowel preparation and shorter operative time are associated with a decreased rate of POI. External validation is essential for the confirmation and further evaluation of our logistic regression model and nomogram.
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Rencüzoğulları et al. (2017) conducted a cohort in Postoperative ileus after colectomy (n=29,201). Clinical risk factors (e.g., open approach, omission of oral antibiotics, prolonged operative time) vs. Absence of risk factors was evaluated on Postoperative ileus (POI). Multiple clinical risk factors, including open approach and omission of oral antibiotics, were associated with a 13.1% incidence of postoperative ileus, accurately predicted by a nomogram (C-index 0.69).
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