Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn's disease

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Inflammatory Bowel Disease

Background:

• Prolonged postoperative ileus (PPOI) is a frequent complication after bowel resections, particularly in Crohn's disease (CD) patients.
• The specific pathophysiology of PPOI, and whether it affects the upper or lower gastrointestinal (GI) tract distinctly, remains incompletely understood.

Purpose of the Study:

• To investigate and differentiate the risk factors associated with upper versus lower PPOI.
• To inform clinical practice and future research by understanding the distinct etiologies of PPOI subtypes.

Main Methods:

• Retrospective analysis of 163 CD patients who underwent ileocecal resection between 2015 and 2020.
• Defined upper PPOI by vomiting or nasogastric tube use beyond postoperative day 3; defined lower PPOI by absence of defecation for over three days.
• Utilized multivariable logistic regression to identify independent risk factors for each PPOI type.

Main Results:

• Overall PPOI incidence was 42.7%, with upper PPOI at 30.7% and lower PPOI at 20.9%.
• Independent risk factors for upper PPOI included older age, resident-performed surgery, hand-sewn anastomosis, prolonged opioid use, and reoperation.
• Independent risk factors for lower PPOI included a BMI ≤ 25 kg/m², preoperative anemia, and the absence of an ileostomy.

Conclusions:

• Distinct risk factors exist for upper and lower PPOI after ileocecal resection in CD.
• A differentiated approach to upper/lower PPOI is recommended for future research and clinical practice.
• Close monitoring of high-risk patients and avoidance of modifiable factors like preoperative anemia and opioids are advised.