Does enhanced recovery reduce postoperative ileus after colorectal surgery?
BACKGROUND
While enhanced recovery after surgery (ERAS) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay, its impact on recovery of bowel motility is poorly documented. The aims of this study were to assess the impact of ERAS on bowel motility recovery, and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature.


METHODS
This is a single-center prospective observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17 months. Global resumption of intestinal transit (GROT) was defined as passage of stool combined with alimentary tolerance of solid food.


RESULTS
One hundred and thirty-one patients were included. A median of 14 items (range: 13-16) was complied out of 19 observable items in the protocol. Median time to passage of flatus (MTPF) was 2 days and the GROT was 3 days. The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased (respectively P<0.001, r2=0.11 and P=0.04, r2=0.06). The incidence of postoperative "ileus" varied from 1.5% to 61.8% depending on the interval chosen to define ileus (cut-off from 1 to 7 days). Adherence to≥85% of the items in the ERAS protocol protected patients from "prolonged ileus", i.e., lasting≥4 days (OR=0.35; 95% CI=0.15 to 0.83).


CONCLUSIONS
The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT. There is a need for a consensual definition of postoperative ileus.
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France; L'UNAM, université d'Angers, 49000 Angers, France.
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Barbieux
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France; L'UNAM, université d'Angers, 49000 Angers, France.
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Hamy
CHU d'Angers, département d'anesthésie-réanimation, 4, rue Larrey, 49933 Angers cedex 9, France.
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Talbot
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France.
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Casa
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France.
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Mucci
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France; L'UNAM, université d'Angers, 49000 Angers, France.
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Lermite
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France; L'UNAM, université d'Angers, 49000 Angers, France; Université de Nantes, institut des maladies de l'appareil digestif, Inserm U 913, 1, rue Gaston-Veil, 44035 Nantes, France. Electronic address: auvenara@yahoo.fr.
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Venara
D000368:Aged; D003082:Colectomy; D005260:Female; D006801:Humans; D045823:Ileus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome
Colorectal surgery; Enhanced recovery after surgery; Improved rehabilitation; Intestinal motility; Postoperative ileus