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Risk Factors for Prolonged Ileus After Resection of Colorectal Cancer: An Observational Study of 2400 Consecutive Patients

Chapuis, Pierre H. DS, FRACS; Bokey, Les MS, FRACS; Keshava, Anil FRACS; Rickard, Matthew J.F.X. FRACS; Stewart, Peter FRACS; Young, Christopher J. FRACS; Dent, Owen F. PhD

doi: 10.1097/SLA.0b013e318268a693
Original Articles

Objective: Prolonged ileus—the failure of postoperative ileus to resolve within a few days after major abdominal surgery—leads to significant medical consequences for the patient and costs to the hospital system. The aim of this retrospective analysis of prospectively collected data was to identify independent preoperative and intraoperative risk factors for prolonged ileus in a large consecutive series of patients who had undergone resection for colorectal cancer.

Methods: Patients were drawn from a hospital registry of 2400 consecutive resections over the period 1995–2009. Thirty-four potential predictors of prolonged ileus were analyzed by logistic regression.

Results: Prolonged ileus occurred in 14.0% of patients. Statistically significant independent predictors of prolonged ileus were male sex (OR: 1.7, P < 0.001), peripheral vascular disease (OR: 1.8, P < 0.001), respiratory comorbidity (OR: 1.6, P < 0.001), resection at urgent operation (OR: 2.2, P < 0.001), perioperative transfusion (OR: 1.6, P < 0.010), stoma constructed (OR: 1.4, P < 0.001), and operation lasting ≥3 hours (OR: 1.6, P < 0.001).

Conclusions: These features can be used to alert medical and nursing staff to patients likely to experience prolonged ileus after bowel resection so that they can be monitored closely in the postoperative period and available treatments targeted toward them. These features may also be useful in the research context to facilitate the more efficient selection of high-risk patients as subjects in clinical trials of prevention or treatment.

Prospectively collected data on 2400 consecutive resections for colorectal cancer were used to examine 34 potential preoperative and operative risk factors for prolonged ileus. Independent predictors of prolonged ileus were male sex, respiratory comorbidity, peripheral vascular disease, resection at urgent operation, perioperative transfusion, stoma construction, and operations of 3 hours or longer.

Department of Colorectal Surgery, Concord Hospital, New South Wales, Australia; and Discipline of Surgery, The University of Sydney, Sydney, Australia.

Reprints: Owen F. Dent, PhD, Department of Colorectal Surgery, Concord Hospital, NSW 2139, Australia. E-mail:

Disclosure: No funding external to Concord Hospital. No author has any conflict of interest in regard to this study.

© 2013 by Lippincott Williams & Wilkins.