[Risk factors for the development of postoperative paralytic ileus after radical cystectomy: a report of 740 cases].
OBJECTIVE
To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus.


METHODS
In the retrospective study, 749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed, of whom, 9 who received orthotopic ileal neobladder were excluded. Of the 740 patients, 82 (11.1%) developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of post-operative paralytic ileus was identified.


RESULTS
The postoperative paralytic ileus was significantly correlated with the patient's age (68 vs. 67, P=0.025), body mass index (23.0 kg/m2 vs.24.1 kg/m2, P=0.008), different urinary diversion reconstruction methods [13.2% (66/500) for ileal conduit and 7.3%(16/240) for cutaneous ureterostomy, P=0.008] and pelvic lymph node dissection [12.2% (77/632) vs.4.6% (5/108), P=0.021].The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery (24 d vs. 17 d, P=0.000). There was no significant correlation between the postoperative paralytic ileus and the patients' gender, previous abdominal operations, preoperative hemoglobin and creatinine, American Society of Anesthesiologists score, operative time, estimated blood loss, transfusion requirement, laparoscopic and open surgery, ICU admission or tumor staging. On multivariate analysis, age (hazard ratio 1.185, 95% confidence interval 1.036-1.355, P=0.013), body mass index (hazard ratio 0.605, 95% confidence interval 0.427-0.857, P=0.005), different urinary diversion reconstruction methods (hazard ratio 2.422, 95% confidence interval 1.323-4.435, P=0.004) and pelvic lymph node dissection (hazard ratio 2.798, 95% confidence interval 1.069-7.322, P=0.036) were significantly correlated with the presence of the postoperative paralytic ileus.


CONCLUSIONS
Increasing age, decreasing BMI, ileal conduiturinary diversion and pelvic lymph node dissection were significantly correlated with the presence of postoperative paralytic ileus in patients undergoing radical cystectomy.
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Yi-sen
YS
Meng
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Yang
Y
Su
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Yu
Y
Fan
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Wei
W
Yu
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Yu
Y
Wang
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Wei
W
Zheng
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Cheng
C
Shen
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Li-qun
LQ
Zhou
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Qian
Q
Zhang
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Xue-song
XS
Li
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Wen-ke
WK
Han
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Zhi-song
ZS
He
Department of Urology,Peking University First Hospital;Institute of Urology,Peking University;National Urological Cancer Center,Beijing 100034,China.
Jie
J
Jin
D001803:Blood Transfusion; D015992:Body Mass Index; D015653:Cystectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007418:Intestinal Pseudo-Obstruction / Q000453:epidemiology*; D007902:Length of Stay; D008197:Lymph Node Excision; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms; D014547:Urinary Diversion