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Prolonged Postoperative Ileus Significantly Increases the Cost of Inpatient Stay for Patients Undergoing Elective Colorectal Surgery

Results of a Multivariate Analysis of Prospective Data at a Single Institution

Mao, Howe, M.B.Ch.B1; Milne, Tony G.E., M.B.B.S.1; O’Grady, Gregory, M.B.Ch.B., F.R.A.C.S., Ph.D1,2; Vather, Ryash, M.B.Ch.B., Ph.D.1; Edlin, Richard, Ph.D3; Bissett, Ian, M.D., F.R.A.C.S.1,2

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 631–637
doi: 10.1097/DCR.0000000000001301
Original Contribution: Socioeconomic
Denotes Associated Video Abstract
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BACKGROUND: Prolonged postoperative ileus is a common major complication after abdominal surgery. Retrospective data suggest that ileus doubles the cost of inpatient stay. However, current economic impact data are based on retrospective studies that rely on clinical coding to diagnose ileus.

OBJECTIVE: The aim of this study was to determine the economic burden of ileus for patients undergoing elective colorectal surgery.

DESIGN: Economic data were audited from a prospective database of patients who underwent surgery at Auckland City Hospital between September 2012 and June 2014.

SETTINGS: Auckland City Hospital is a large tertiary referral center, using an enhanced recovery after surgery protocol.

PATIENTS: Patients were prospectively diagnosed with prolonged postoperative ileus using a standardized definition.

MAIN OUTCOME MEASURES: The cost of inpatient stay was analyzed with regard to patient demographics and operative and postoperative factors. A multivariate analysis was performed to determine the cost of ileus when accounting for other significant covariates.

RESULTS: Economic data were attained from 325 patients, and 88 patients (27%) developed ileus. The median inpatient cost (New Zealand dollars) for patients with prolonged ileus, including complication rates and length of stay, was $27,981 (interquartile range= $20,198 to $42,174) compared with $16,317 (interquartile range = $10,620 to $23,722) for other patients, a 71% increase in cost (p < 0.005). Ileus increased all associated healthcare costs, including medical/nursing care, radiology, medication, laboratory costs, and allied health (p < 0.05). Multivariate analysis showed that ileus remained a significant financial burden (p < 0.005) when considering rates of major complications and length of stay.

LIMITATIONS: This is a single-institution study, which may impact the generalizability of our results.

CONCLUSIONS: Prolonged ileus causes a substantial financial burden on the healthcare system, in addition to greater complication rates and length of stay in these patients. This is the first study to assess the financial impact of prolonged ileus, diagnosed prospectively using a standardized definition. See Video Abstract at

1 Department of Surgery, University of Auckland, Auckland, New Zealand

2 Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand

3 Department of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Funding/Support: Dr Milne is funded through a Clinical Research Training Fellowship awarded by the Health Research Council of New Zealand.

Financial Disclosure: None reported.

Howe Mao and Tony G.E. Milne contributed equally to this article.

Presented at the meeting of Royal Australian College of Surgeons Surgical Research Society, Adelaide, South Australia, Australia, November 8 to 11, 2017.

Correspondence: Ian Bissett, M.D., F.R.A.C.S., Department of Surgery, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, Auckland, New Zealand. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons