Multicentre observational study of gastrointestinal recovery after elective colorectal surgery

• Published in: Colorectal disease Vol. 20; no. 6; pp. 536 - 544
• Main Authors: Tahir, W., Bolton, W., Pericleous, A., Saeed, F., Sheikh, S., Silva, A. N., Maslekar, S., Jayne, D. G., Altunel, M., Hirst, N. A., Khan, A., Ashmore, D., Wilkins, A., Wong, C., Edwards, C. S., Nduka, A., Richards, E. R., Mori, G., Ali, H., Amin, I., Athanasiou, C., Farooq, M., Hardie, C., Khan, U., O'Neill, C., Sturgess, G., Ebbitt, G., Wells, D., Sakellaropoulos, S., Asmar, S., Friend, C., Habib, S., Jarral, F., Phillips, M. E., Suhail, A., Young, R. S., Dykes, G., Gissing, S., Thomas, B., Mercer, C., Wellby, G., Jackson, A., Singh, S., Flynn, L., Lloyd Jones, K., Parkash, A., Simpson, L. J., Shields, S. L., Soni, B. H., Thethi, R., Elsayeh, K., Ezerska, E. A., Gnanapragasam, S. N., Williams, J., Wright, L. N. G.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2018
• Subjects: Adolescent; Adult; Bronchopneumonia; Bronchopneumonia - epidemiology; Chewing Gum; Colectomy; Colorectal Neoplasms - surgery; Colorectal surgery; Colostomy; Elective Surgical Procedures; Female; gastrointestinal transit; Humans; Ileus - epidemiology; Ileus - physiopathology; Incidence; Inflammatory Bowel Diseases - surgery; Insertion; Intestine; Intubation, Gastrointestinal - statistics & numerical data; Male; Mastication; Middle Aged; Observational studies; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; postoperative ileus; Proctectomy; Proctocolectomy, Restorative; Receptors, Opioid, mu - antagonists & inhibitors; Recovery of Function; Reoperation; Surgery; Time Factors; United Kingdom; Vomiting; Vomiting - epidemiology; Young Adult; United Kingdom; Colorectal surgery; postoperative ileus; gastrointestinal transit
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13949

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.