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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery

Hedrick, Traci L., MD, MS*; McEvoy, Matthew D., MD; Mythen, Michael (Monty) G., MBBS, MD, FRCA, FFICM, FCAI (Hon); Bergamaschi, Roberto, MD, PhD§; Gupta, Ruchir, MD; Holubar, Stefan D., MD, MS; Senagore, Anthony J., MD, MS, MBA#; Gan, Tong Joo, MD, MHS, FRCA; Shaw, Andrew D., MB, FRCA, FCCM, FFICM; Thacker, Julie K. M., MD**; Miller, Timothy E., MB, ChB, FRCA††; Wischmeyer, Paul E., MD, EDIC; Carli, Franco, MD, MPhil; Evans, David C., MD, FACS; Guilbert, Sarah, RD, LDN, CNSC; Kozar, Rosemary, MD, PhD; Pryor, Aurora, MD, FACS; Thiele, Robert H., MD; Everett, Sotiria, EdD, RD; Grocott, Mike, BSc, MBBS, MD, FRCA, FRCP, FFICM; Abola, Ramon E., MD; Bennett-Guerrero, Elliott, MD; Kent, Michael L., MD; Feldman, Liane S., MD; Fiore, Julio F. Jr, PhD for the Perioperative Quality Initiative (POQI) 2 Workgroup

doi: 10.1213/ANE.0000000000002742
Perioperative Medicine: Narrative Review Article

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.

From the *Department of Surgery, University of Virginia Health System, Charlottesville, Virginia

Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee

Department of Anaesthesia, University College London, London, United Kingdom

§Division of Colon and Rectal Surgery, Westchester Medical Center, Valhalla, New York

Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, New York

Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

#Department of Surgery, University of Texas Medical Branch, Galveston, Texas

**Division of Advanced Oncologic and Gastrointestinal Surgery

††Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, North Carolina.

Professor of Anesthesiology and Surgery, Director of Perioperative Research, Duke Clinical Research Institute, Director, Nutrition Support Service, Duke University Hospital, Duke University School of Medicine, Durham, North Carolina

Professor of Anesthesia, McGill University, Montreal, Québec, Canada

Associate Professor of Surgery, Medical Director, Level 1 Trauma Center and Nutrition Support Service, Department of Surgery, Division of Trauma, Critical Care, and Burn, Columbus, Ohio

Clinical Dietitian Duke Nutrition Support Team/POET Clinic, Duke University Hospital, Durham, North Carolina

Director of Research, Shock Trauma, Associate Director of Shock Trauma Anesthesia Research [STAR] Center, Professor of Surgery, University of Maryland School of Medicine, Baltimore, Maryland

Professor of Surgery, Chief Bariatric, Foregut and Advanced GI Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, New York

Assistant Professor, Departments of Anesthesiology and Biomedical Engineering, Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, Co-Director, UVA Enhanced Recovery after Surgery [ERAS] Program, University of Virginia School of Medicine, Charlottesville, Virginia

Clinical Assistant Professor, Nutrition Division, Department of Family, Population, Preventive Medicine, Stony Brook Medicine, Stony Brook, New York

Respiratory and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, United Kingdom; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York

Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York

Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland

Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Québec, Canada

Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Québec, Canada

Published ahead of print December 29, 2017.

Accepted for publication October 27, 2017.

Funding: The Perioperative Quality Initiative (POQI) meeting received financial assistance from the American Society for Enhanced Recovery (ASER).

Conflicts of Interest: See Disclosures at the end of the article.

Members of the Perioperative Quality Initiative (POQI) 2 Workgroup are provided in the Appendix.

Reprints will not be available from the authors.

Address correspondence to Timothy E. Miller, MB, ChB, FRCA, Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to timothy.miller2@duke.edu.

© 2018 International Anesthesia Research Society
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