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首页> 外文期刊>Surgical Endoscopy >Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway
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Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway

机译：在增强良好的恢复途径背景下结直肠手术后长期术后Ileus的发病率和预测

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BackgroundProlonged postoperative ileus (PPOI) is common after colorectal surgery but has not been widely studied in the context of enhanced recovery pathways (ERPs) that include interventions aimed to accelerate gastrointestinal recovery. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery.MethodsWe analyzed data from an institutional colorectal surgery ERP registry. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and absence of flatus or bowel movement for 4days) 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). Results are presented as posterior effect probability (PEP). Evidence of association was categorized as: no evidence (PEP 99%).ResultsThere were 323 patients analyzed (mean age 63.5years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11 and 59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48h (PEP 94%; strong evidence), postoperative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3ml/kg/h for laparoscopic and 5ml/kg/h for open; PEP 55%, weak evidence) were predictors of PPOI.ConclusionsThe incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably by 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.
机译：背景突出的术后肠杆菌（PPOI）在结肠直肠手术后常见，但尚未在增强的恢复途径（ERP）的背景下广泛研究，包括旨在加速胃肠恢复的干预措施。本研究的目的是估算PPOI在结肠直肠外科的ERP的情况下PPOI的发病率和预测因子。方法从制度结直肠外科再生ERP注册表中分析了数据。根据从vather（固体食物的不耐受或4天的肠胃运动的不耐受或肠道运动的不耐受的定义，并与文献中的其他定义相比，PPOI的发病率估计。从先前的研究中确定了PPOI的潜在风险因素，并使用贝叶斯模型平均（BMA）评估其预测能力。结果显示为后效概率（PEP）。关联证据被分类为：没有证据（PEP 99％）。结果是323名患者分析（平均63.5岁，51％，74％腹腔镜，33％的直肠切除术）。根据主要定义，PPOI的发生率为19％，但使用其他定义时的10％至10％。在BMA分析中，术中失血（PEP 99％;非常有力的证据），在前48H（PEP 94％;强大的证据），术后硬膜外镇痛（PEP 56％;证据）和非符合术中的流体管理方案（腹腔镜3ml / kg / h用于开放的5ml / kg / h; PEP 55％，弱证据）是ppoi的预测因子。结肠直肠手术后PPOI的发生率即使在建立中也是高的通过诊断标准，ERP和各种各样的变化，突出了对共识定义的需求。静脉内阿片类药物的使用是ERP内PPOI的可改性强预测因子，而硬膜外镇痛和术中流体管理的作用应进一步评估。

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