title: Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery.
abstract: OBJECTIVE
  There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification.
  
  
  METHODS
  A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons.
  
  
  RESULTS
  A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations.
  
  
  CONCLUSIONS
  This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.
authors.affiliation: Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933 Cedex 9, Angers, France. auvenara@yahoo.fr.|LUNAM, University of Angers, Angers, France. auvenara@yahoo.fr.|UMR INSERM U1235 - TENS, School of Medicine University of Nantes, 1 rue Gaston Veil, 44035, Nantes, France. auvenara@yahoo.fr.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Venara
authors.affiliation: Department of Visceral Surgery, CHU Estaing, Clermont Ferrand, France.
authors.forename: Karem
authors.initials: K
authors.lastname: Slim
authors.affiliation: Visceral and Endocrinal Surgery Department, University Hospital of Amiens, Amiens, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Department of Digestive and Endocrine Surgical Oncology, University Hospital of Dijon, Dijon, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortega-Deballon
authors.affiliation: Department of Biostatistics, University Hospital of Angers, Angers, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vielle
authors.affiliation: Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933 Cedex 9, Angers, France.|LUNAM, University of Angers, Angers, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.affiliation: UMR INSERM U1235 - TENS, School of Medicine University of Nantes, 1 rue Gaston Veil, 44035, Nantes, France.|Visceral and Endocrinal Surgery Department, University Hospital of Nantes, 1 rue Gaston Veil, 44035, Nantes Cedex, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Meurette
authors.affiliation: Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933 Cedex 9, Angers, France.|LUNAM, University of Angers, Angers, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Hamy
mesh_terms: D003107:Colorectal Surgery; D006801:Humans; D045823:Ileus / Q000145:classification* / Q000209:etiology*; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Classification; Postoperative ileus; Postoperative morbidity