Ileus After Colectomy in the Modern Era: A Population-Based Analysis.

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Health Services Research

Background:

• Postoperative ileus (POI) is a frequent complication following colectomy, leading to increased healthcare utilization and patient morbidity.
• Despite the widespread adoption of enhanced recovery pathways in Michigan hospitals, the clinical relevance of POI persists.

Purpose of the Study:

• To investigate the current burden of postoperative ileus after elective colectomy.
• To identify patient, hospital, perioperative, and surgical risk factors associated with POI.

Main Methods:

• A retrospective analysis was conducted on 9,571 patients undergoing elective colectomy across 70 hospitals in the Michigan Surgical Quality Collaborative from 2018-2023.
• Multivariable logistic regression identified independent risk factors for POI, defined as no oral intake for ≥4 postoperative days or nasogastric tube insertion within 30 days.
• Risk-adjusted hospital rates of POI were compared.

Main Results:

• The overall incidence of POI was 6.56%, with significant hospital variation (0.79%–22.0%).
• POI was independently associated with total colectomy, larger hospital size, male sex, immunosuppressants, non-white race, COPD, sleep apnea, and older age (>65 years).
• Factors decreasing POI included minimally invasive surgery, alvimopan use, ambulation within 24 hours, and diverticular disease.

Conclusions:

• While POI rates may reflect advancements in enhanced recovery and minimally invasive colectomy, total colectomy presents a higher risk.
• Minimally invasive approaches, perioperative alvimopan, and early ambulation are key strategies to further mitigate POI.
• Significant hospital-level variation in POI rates underscores the need for standardized best practices.