title: Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy.
abstract: OBJECTIVE
  To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus (POI). POI is a common complication after radical cystectomy and can result in a prolonged hospital stay and delayed recovery.
  
  
  METHODS
  A retrospective cohort study design was used to analyze data from consecutive patients presenting to our institution for radical cystectomy with pelvic nodal dissection. POI was declared if patients were without evidence of bowel function beyond the anticipated discharge goal of 6 days. The association between several clinical features and the occurrence of POI was examined.
  
  
  RESULTS
  Of 283 patients, 43 (15.2%) developed POI. Of the 43 patients, 38 (88.4%) were given total parenteral nutrition for nutritional supplementation. No difference in the incidence of POI was observed between the sexes, previous abdominal operations, estimated blood loss, transfusion requirement, operative time, neoadjuvant chemotherapy, or previous radiotherapy. POI was observed in 11.3% of normal and overweight patients (body mass index [BMI] <30.0 kg/m(2)) compared with 25.6% of obese patients (BMI ≥30.0 kg/m(2); P = .005). On multivariate analysis adjusted for the influence of competing variables, increasing age (hazard ratio 1.09, 95% confidence interval 1.02-1.16, P = .008) and BMI (hazard ratio 1.09, 95% confidence interval 1.03-1.17, P = .007) were significantly associated with the presence of POI.
  
  
  CONCLUSIONS
  Our results showed that increasing age and BMI were significantly associated with the presence of POI in patients undergoing radical cystectomy for bladder cancer.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Mark B
authors.initials: MB
authors.lastname: Fisher
authors.forename: Michael B
authors.initials: MB
authors.lastname: Williams
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Nogueras-González
authors.forename: Diana L
authors.initials: DL
authors.lastname: Urbauer
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000453:epidemiology* / Q000209:etiology; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery; D014547:Urinary Diversion