干预靶点？加速康复方案下结直肠手术后术后肠梗阻的术前预测因素。

Targets for Intervention? Preoperative Predictors of Postoperative Ileus After Colorectal Surgery in an Enhanced Recovery Protocol.

机构信息

Department of Surgery, Division of Colorectal Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 603 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.

Epidemiology Data Center Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.

出版信息

J Gastrointest Surg. 2021 Aug;25(8):2065-2075. doi: 10.1007/s11605-020-04876-0. Epub 2020 Nov 17.

DOI:10.1007/s11605-020-04876-0

PMID:33205308

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8126638/

Abstract

BACKGROUND

Postoperative ileus occurs in up to 30% of colorectal surgery patients and is associated with increased length of stay, costs, and morbidity. While Enhanced Recovery Protocols seek to accelerate postoperative recovery, data on modifiable preoperative factors associated with postoperative ileus in this setting are limited. We aimed to identify preoperative predictors of postoperative ileus following colorectal surgery in Enhanced Recovery Protocols, to determine new intervention targets.

METHODS

We performed a retrospective single-center cohort study of patients ≥ 18 years old who underwent colorectal surgery via Enhanced Recovery Protocols (7/2015-7/2017). Postoperative ileus was defined as nasogastric tube insertion postoperatively or nil-per-os by postoperative day 4. Preoperative risk factors including comorbidities and medication use were identified using multivariable stepwise logistic regression.

RESULTS

Of 530 patients, 14.9% developed postoperative ileus. On univariate analysis of perioperative and postoperative factors, postoperative ileus patients had increased psychiatric illness, antidepressant and antipsychotic use, American Society of Anesthesiologists classification, ileostomy creation, postoperative opioid use, complications, surgery duration, and length of stay (p < 0.05). Multivariable logistic regression model for preoperative factors identified psychiatric illness, preoperative antipsychotic use, and American Society of Anesthesiologists classification ≥ 3 as significant predictors of postoperative ileus (p < 0.05).

DISCUSSION

Postoperative ileus remains a common complication following colorectal surgery under Enhanced Recovery Protocols. Patients with pre-existing psychiatric comorbidities and preoperative antipsychotic use may be a previously overlooked cohort at increased risk for postoperative ileus. Additional research and preoperative interventions within Enhanced Recovery Protocols to reduce postoperative ileus for this higher-risk population are needed.

摘要

背景

术后肠梗阻在多达 30%的结直肠手术患者中发生，与住院时间延长、费用增加和发病率增加有关。虽然强化康复方案旨在加速术后恢复，但关于与该环境下术后肠梗阻相关的可改变术前因素的数据有限。我们旨在确定强化康复方案中结直肠手术后术后肠梗阻的术前预测因素，以确定新的干预目标。

方法

我们对 2015 年 7 月至 2017 年 7 月期间接受强化康复方案的年龄≥18 岁的患者进行了回顾性单中心队列研究。术后肠梗阻定义为术后插入鼻胃管或术后第 4 天禁食。使用多变量逐步逻辑回归确定术前危险因素，包括合并症和药物使用情况。

结果

在 530 例患者中，14.9%发生术后肠梗阻。在对围手术期和术后因素进行单因素分析时，术后肠梗阻患者存在更多的精神疾病、抗抑郁药和抗精神病药使用、美国麻醉医师协会分类、造口术、术后阿片类药物使用、并发症、手术时间和住院时间（p<0.05）。术前因素的多变量逻辑回归模型确定精神疾病、术前抗精神病药使用和美国麻醉医师协会分类≥3 是术后肠梗阻的显著预测因素（p<0.05）。