Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2020 Aug;32(8):e13862. doi: 10.1111/nmo.13862. Epub 2020 May 13.
Colorectal surgery is associated with postoperative ileus (POI). Despite its widespread manifestation, the influence of POI on recovery, quality of life (QoL), and costs is largely unknown. The aim of this study was to assess whether the inflammatory processes found in experimental studies are also evident in patients undergoing colorectal surgery. In addition, the impact of POI on short and long-term QoL and costs was investigated.
We analyzed the outcomes of the SANICS-II trial, including prospective evaluation of inflammatory parameters in blood samples, costs from a societal perspective and QoL, using validated questionnaires. Outcomes were compared between patients with and without POI, and in particular patients with POI as unique complication.
A total of 265 patients (POI, n = 66 vs non-POI, n = 199) were included and 38/66 had POI as only complication. CRP levels were significantly increased on postoperative day (POD) 1, 2, 3, and 4 in patients with POI. Furthermore, plasma levels of cytokines IL-6, Il-8 and IL-10 were significantly increased the first 2 days after resection. Patients with POI had a higher overall complication rate and a reduced QoL 3 months postoperatively, even in the only POI group. Moreover, mean societal cost per patient with POI was 38%-47% higher at 3 months postoperatively.
CONCLUSIONS & INFERENCES: Supporting findings from experimental studies, inflammatory parameters were increased in patients with only POI and comparable with all patients with POI. These results demonstrate the impact and large contribution of POI in postoperative inflammation, costs and QoL in patients undergoing colorectal surgery.
结直肠手术后会发生术后肠梗阻（POI）。尽管 POI 广泛存在，但它对恢复、生活质量（QoL）和成本的影响在很大程度上是未知的。本研究旨在评估在接受结直肠手术的患者中是否也存在实验研究中发现的炎症过程。此外，还研究了 POI 对短期和长期 QoL 和成本的影响。
我们分析了 SANICS-II 试验的结果，包括从社会角度评估炎症参数、成本和 QoL，使用了经过验证的问卷。将有和没有 POI 的患者以及仅患有 POI 的患者进行比较，并进行了比较。
共纳入 265 例患者（POI，n=66 例；非 POI，n=199 例），其中 38/66 例患者仅患有 POI。POI 患者术后第 1、2、3 和 4 天 CRP 水平显著升高。此外，POI 患者术后第 1 和第 2 天的细胞因子 IL-6、IL-8 和 IL-10 血浆水平显著升高。POI 患者的总体并发症发生率较高，术后 3 个月 QoL 降低，即使在仅 POI 组也是如此。此外，术后 3 个月，每例 POI 患者的社会总成本平均增加 38%-47%。
支持实验研究的结果，仅 POI 患者的炎症参数增加，与所有 POI 患者的情况相当。这些结果表明，POI 在结直肠手术后的炎症、成本和 QoL 中具有重要影响和巨大贡献。
