Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba, Japan.
Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
J Gastrointest Surg. 2018 Mar;22(3):508-515. doi: 10.1007/s11605-017-3622-8. Epub 2017 Nov 8.
Prolonged postoperative ileus (PPOI) is among the common complications adversely affecting postoperative outcomes. Predictors of PPOI after major abdominal surgery remain unclear, although various PPOI predictors have been reported in patients undergoing colorectal surgery. This study aimed to devise a model for stratifying the probability of PPOI in patients undergoing abdominal surgery.
Between 2012 and 2013, 841 patients underwent major abdominal surgery after excluding patients who underwent less-invasive abdominal surgery, ileus-associated surgery, and emergency surgery. Postoperative managements were generally based on enhanced recovery after surgery (ERAS) program. The definition of PPOI was based on nausea, no oral diet, flatus absence, abdominal distension, and radiographic findings. A nomogram was devised by evaluating predictive factors for PPOI.
Of the 841 patients, 73 (8.8%) developed PPOI. Multivariable logistic regression analysis revealed smoking history (P = 0.025), colorectal surgery (P = 0.004), and an open surgical approach (P = 0.002) to all be independent predictive factors for PPOI. A nomogram was devised by employing these three significant predictive factors. The prediction model showed relatively good discrimination performance, the concordance index of which was 0.71 (95%CI 0.66-0.77). The probability of PPOI in patients with a smoking history who underwent open colorectal surgery was calculated to be 19.6%.
Colorectal surgery, open abdominal surgery, and smoking history were found to be independent predictive factors for PPOI in patients who underwent major abdominal surgery. A nomogram based on these factors was shown to be useful for identifying patients with a high probability of developing PPOI.
术后肠麻痹（PPOI）是影响术后转归的常见并发症之一。尽管有报道称各种 PPOI 预测因素存在于接受结直肠手术的患者中，但仍不清楚导致主要腹部手术后 PPOI 的预测因素。本研究旨在设计一种用于分层评估腹部手术后患者 PPOI 概率的模型。
2012 年至 2013 年间，841 例患者接受了主要腹部手术，但排除了接受微创腹部手术、与肠麻痹相关手术和急诊手术的患者。术后管理通常基于加速康复外科（ERAS）方案。PPOI 的定义基于恶心、无口服饮食、无肛门排气、腹胀和影像学发现。通过评估 PPOI 的预测因素来设计一个列线图。
841 例患者中，73 例（8.8%）发生 PPOI。多变量逻辑回归分析显示，吸烟史（P=0.025）、结直肠手术（P=0.004）和开放式手术方法（P=0.002）均为 PPOI 的独立预测因素。通过采用这三个重要的预测因素，设计了一个列线图。预测模型显示出较好的区分性能，其一致性指数为 0.71（95%CI 0.66-0.77）。在接受开腹结直肠手术且有吸烟史的患者中，PPOI 的概率预计为 19.6%。
结直肠手术、开放式腹部手术和吸烟史是导致接受主要腹部手术的患者发生 PPOI 的独立预测因素。基于这些因素的列线图可用于识别发生 PPOI 概率较高的患者。
