Details

Autor(en) / Beteiligte

• Nazzani, Sebastiano
• Bandini, Marco
• Preisser, Felix
• Mazzone, Elio
• Marchioni, Michele
• Tian, Zhe
• Stubinski, Robert
• Clementi, Maria Chiara
• Saad, Fred
• Shariat, Shahrokh F.
• Montanari, Emanuele
• Briganti, Alberto
• Carmignani, Luca
• Karakiewicz, Pierre I.

Titel

Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis

Ist Teil von

• Surgical oncology, 2019-03, Vol.28, p.201-207

Ort / Verlag

Netherlands: Elsevier Ltd

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs. •Between 2003 and 2013, the estimated annual paralytic ileus rate did not change.•The highest rate of paralytic ileus was recorded after cystectomy.•Paralytic ileus after major oncological surgical procedure was associated with elevated total hospital charges.•Paralytic ileus after major oncological surgical procedure was associated with prolonged in-hospital length of stay.