Prolonged Postoperative Ileus in Colorectal Surgery Within an Enhanced Recovery Protocol: a Multivariate Analysis

Prolonged postoperative ileus (PPOI) is a significant cause of postoperative morbidity contributing to delayed hospital discharge and increased treatment costs. The aim of this study was to identify factors influencing prolonged postoperative ileus within a cohort of patients undergoing colorectal surgery within an early recovery after surgery (ERAS) protocol. Data were collected from a prospectively managed database of patients undergoing colorectal surgery within an ERAS protocol. Patient characteristics, operative details and ERAS protocol items were tested to see if they were associated with PPOI. Fisher’s tests were used for categorical variables, and Student’s t tests were used for continuous variables. Factors with p-values less than 0.05 in univariate analysis were included in a multivariate logistic regression model to identify independent factors influencing PPOI. A total of 374 patients who underwent colorectal resections between April 2016 and May 2020 were included in the study. Prolonged postoperative ileus occurred in sixty-two patients (16.6%). Early feeding, early mobilisation, mechanical bowel preparation, mini-invasive approaches and rectal surgery were more frequent in patients without PPOI. Right hemicolectomy and a history of previous major abdominal surgery were more frequent in patients with PPOI. On multivariate analysis, early mobilisation and mini-invasive approaches were identified as independent protective factors and major abdominal surgery as an independent risk factor. Awareness of the identified factors is important for improving outcome of patients after colorectal surgery.