Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
McGill University Health Centre, 1001 Boul. Decarie, DS1-3310, Montreal, QC, H4A 3J1, Canada.
Surg Endosc. 2020 May;34(5):2219-2226. doi: 10.1007/s00464-019-07011-6. Epub 2019 Jul 30.
Postoperative ileus (POI) is common after gastrointestinal surgery and is associated with significant morbidity and costs. However, POI is poorly defined. The I-FEED score is a novel outcome measure for POI, developed by expert consensus. It contains five elements (intake, response to nausea treatment, emesis, exam, and duration, each scored with 0, 1, or 3 points) and classifies patients into normal, postoperative gastrointestinal intolerance (POGI), and postoperative gastrointestinal dysfunction (POGD). However, it has not yet been validated in a clinical context. The objective was to provide validity evidence for the I-FEED score to measure the construct of POI in patients undergoing colorectal surgery.
Data previously collected from a clinical trial investigating the impact of different perioperative fluid management strategies on primary POI in patients undergoing elective laparoscopic colectomy (2013-2015) were analyzed. Patients were managed by a longstanding Enhanced Recovery program (expected length of stay (LOS): 3 days). Daily I-FEED scores were generated (normal 0-2, POGI 3-5, POGD 6+ points) up to hospital discharge or postoperative day 7. Validity was assessed by testing the hypotheses that I-FEED score was higher (1) in patients with longer time to GI3 (tolerating diet + flatus/bowel movement), (2) with longer LOS (> 3 days vs shorter), (3) in patients with complications vs without, (4) in patients with poorer recovery (measured by Quality of Recovery-9 questionnaire).
A total of 128 patients were included for analysis (mean age 61.7 years (SD 15.2), 57% male, 71% malignancy, and 39.1% rectal resection). Median LOS was 4 days [IQR3-5], and 32% experienced postoperative in-hospital morbidity. Overall, 48% of patients were categorized as normal, 22% POGI, and 30% POGD. The data supported all 4 hypotheses.
This study contributes preliminary validity evidence for the I-FEED score as a measure for POI after colorectal surgery.
胃肠道手术后常发生术后肠梗阻（POI），并伴有显著的发病率和费用。然而，POI 的定义很差。I-FEED 评分是一种新的 POI 结局测量方法，由专家共识开发。它包含五个元素（摄入、对恶心治疗的反应、呕吐、检查和持续时间，每个元素评分 0、1 或 3 分），并将患者分为正常、术后胃肠道不耐受（POGI）和术后胃肠道功能障碍（POGD）。然而，它尚未在临床环境中得到验证。目的是为 I-FEED 评分提供有效性证据，以衡量接受结直肠手术的患者的 POI 结构。
对先前从一项研究不同围手术期液体管理策略对择期腹腔镜结肠切除术患者原发性 POI 影响的临床试验中收集的数据进行了分析（2013-2015 年）。患者接受了长期强化康复方案（预计住院时间（ LOS ）：3 天）。直到出院或术后第 7 天，每天生成 I-FEED 评分（正常 0-2 分，POGI 3-5 分，POGD 6+ 分）。通过测试以下假设来评估有效性，即 I-FEED 评分更高：（1）胃肠道恢复时间较长（耐受饮食+放屁/排便）的患者，（2） LOS 较长（>3 天比较短）的患者，（3）有并发症的患者比没有并发症的患者，（4）恢复较差的患者（通过质量恢复-9 问卷测量）。
共纳入 128 例患者进行分析（平均年龄 61.7 岁（SD 15.2），57%为男性，71%为恶性肿瘤，39.1%为直肠切除术）。中位 LOS 为 4 天[IQR3-5]，32%的患者发生术后院内并发症。总体而言，48%的患者被归类为正常，22%为 POGI，30%为 POGD。数据支持所有 4 个假设。
本研究为 I-FEED 评分作为结直肠手术后 POI 的测量方法提供了初步的有效性证据。
