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Multicentre observational study of gastrointestinal recovery after elective colorectal surgery
Author(s) -
Wasif Tahir,
William Bolton,
Agamem Pericleous,
Adam A Saeed,
Sophia Sheikh,
Arnaldo Neves Santos Silva,
Laurence Astill Wright
Publication year - 2018
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13949
Subject(s) - medicine , observational study , gastrointestinal function , incidence (geometry) , ileus , colorectal surgery , surgery , elective surgery , psychological intervention , abdominal surgery , physics , optics , psychiatry
Aim Postoperative ileus ( POI ) is characterised by delayed gastrointestinal recovery and is common after colorectal surgery. Numerous strategies to optimise POI have been proposed but its management remains an unmet clinical need. This study aimed to characterise the duration and management of gastrointestinal recovery in patients undergoing elective colorectal surgery. Method A snapshot, prospective, observational study was undertaken between November 2016 and January 2017 at 10 regional hospitals in the United Kingdom. Adult patients undergoing elective colorectal surgery with resection of bowel or reversal of stoma were included. Outcomes included time until return of gastrointestinal function, timing of nasogastric tube ( NGT ) insertion, uptake of targeted interventions and clinical outcomes. Data were validated for accuracy by independent investigators. Results 204 patients met the eligibility criteria. The median time for gastrointestinal recovery was 3 days ( IQR 2–4); right‐sided resections were associated with longer gastrointestinal recovery than left sided (4 days (2.75–5.25) vs 3 days (2–4); P = 0.002). The rate of NGT insertion was 22.5% at a median time of 4 (4–4.75) days. NGT insertion after vomiting was associated with a higher incidence of bronchopneumonia compared to early placement (13.3% vs 29.0%). Targeted interventions, such as chewing gum (4.4%), selective mu‐receptor antagonists (1.0%) and pro‐kinetic agents (13.7%) were infrequently used. Conclusion The average time to gastrointestinal recovery after elective colorectal surgery was three days. Late NGT insertion was associated with an increased incidence of bronchopneumonia. The clinical uptake of targeted interventions to improve gastrointestinal recovery was poor.