[Analysis of risk factors for prolonged postoperative ileus after segmental jejunectomy]

Objective: To explore the risk factors of prolonged postoperative ileus (PPOI) after segmental jejunectomy by propensity score matching (PSM). Methods: This study was designed as a case-control study. The inclusion criteria were as follows: (1) age >18 years; (2) receipt of segmental jejunal resection; (3) postoperative pathological diagnosis of benign jejunal lesions, including small intestinal polyps, small intestinal diverticulitis, small intestinal diverticula, benign small intestinal tumors, small intestinal ulcers, small intestinal hemangioma, small intestinal vascular malformation, and ectopic pancreas of the jejunum, as well as gastrointestinal stromal tumors, lymphoma, or adenocarcinoma; and (4) complete clinical and pathological data.The exclusion criteria were as follows: (1) concomitant other malignancies; (2) combined resection of other organs; (3) emergency surgery due to intestinal obstruction, perforation, or other conditions, including intestinal bleeding, jejunal injury, jejunal rupture, acute enteritis, acute hemorrhagic necrotizing enteritis, acute intestinal obstruction, and mesenteric arterial thrombosis; (4) preoperative constipation; and (5) postoperative complications other than PPOI of Clavien-Dindo grade II or higher, or inflammatory reactions involving intra-abdominal organs, such as peritonitis, cholecystitis, or pancreatitis. According to the above criteria, clinicopathological data of patients who underwent elective segmental jejunal resection at the General Surgery Center of Beijing Friendship Hospital, Capital Medical University, between July 2013 and June 2025 were retrospectively collected. After screening, 262 patients were included and divided into the PPOI group (n = 42) and the non-PPOI group (n = 220) according to the occurrence of PPOI. Propensity score matching was performed using the nearest-neighbor matching method with a caliper value of 0.1 at a 1∶1 ratio. Logistic regression analysis was used to identify risk factors for PPOI after segmental jejunal resection. Results: Among the 262 patients who underwent elective segmental jejunal resection, PPOI occurred in 42 patients, with an incidence rate of 16.1%. After propensity score matching (PSM), 42 matched pairs of patients were successfully generated. After matching, there were no statistically significant differences between the PPOI and non-PPOI groups in terms of disease type, surgical approach, maximum lesion diameter, or anastomotic method (P>0.05). The PPOI group had significantly higher age, postoperative length of hospital stay, and postoperative C-reactive protein levels than the non-PPOI group, whereas the distance from the lesion center to the ligament of Treitz, postoperative serum potassium levels, and albumin levels were significantly lower in the PPOI group (P<0.05). Univariate analysis showed that a distance from the lesion center to the ligament of Treitz of <30 cm, postoperative serum potassium level of <3.5 mmol/L, postoperative C-reactive protein level of >85 mg/L, and postoperative albumin level of <33 g/L were associated with the occurrence of PPOI after segmental jejunal resection (P<0.05). Multivariate analysis showed that a distance from the lesion center to the ligament of Treitz of <30 cm (OR=8.481, 95%CI: 2.102-34.223, P=0.003), postoperative serum potassium level of <3.5 mmol/L (OR = 16.600, 95%CI: 3.869-71.230, P=0.011), and postoperative C-reactive protein level of >85 mg/L (OR=6.168, 95%CI: 1.514-25.128, P=0.007) were independent risk factors for PPOI after segmental jejunal resection. Conclusions: Patients undergoing proximal jejunal resection, defined as a distance from the lesion center to the ligament of Treitz of <30 cm, as well as those with postoperative hypokalemia and elevated C-reactive protein levels, are at a higher risk of developing PPOI.