Bibliography

Rate of POI

Asgeirsson, T., El-Badawi, K. I., Mahmood, A., Barletta, J., Luchtefeld, M., & Senagore, A. J. (2010). Postoperative ileus: it costs more than you expect. Journal of the American College of Surgeons, 210(2), 228–231. 

https://pubmed.ncbi.nlm.nih.gov/20113944/

Demonstrated a 24% incidence of postoperative ileus in colectomy procedures using an operational definition that included return to NPO status. This is important because of the multiple definitions of POI in the literature, of which many aren’t clinically significant events

Goldstein, J. L., Matuszewski, K. A., Delaney, C. P., Senagore, A., Chiao, E. F., Shah, M., Meyer, K., & Bramley, T. (2007). Inpatient economic burden of postoperative ileus associated with abdominal surgery in the United States. P AND T, 32(2), 82.

Novel study of 160 the coded incidence of POI in 160 hospitals in a national comparative database. While they acknowledge that POI is certainly under coded, the rate of coded POI for small and large intestinal surgery respectively was 14.9% and 19.2%.

Venara, A., Meillat, H., Cotte, E., Ouaissi, M., Duchalais, E., Mor-Martinez, C., Wolthuis, A., Regimbeau, J. M., Ostermann, S., Hamel, J. F., Joris, J., Slim, K., & GRACE Collaborative Group For Ileus Study. (2020). Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis. World Journal of Surgery, 44(3), 957–966. 

https://pubmed.ncbi.nlm.nih.gov/31720793/

This study focused on the incidence of POI in enhanced recovery programs for colorectal surgery. They assessed the incidence of POI in a prospective registry of colorectal resection across 40 centers in five different countries. Importantly, all patients in this study were cared for under an enhanced recovery program. The incidence of POI was 15%. Interestingly, compliance with the enhanced recovery protocol was not associated with reduced rate of POI.

Rate and Cause of Readmissions

Asgeirsson, T., El-Badawi, K. I., Mahmood, A., Barletta, J., Luchtefeld, M., & Senagore, A. J. (2010). Postoperative ileus: it costs more than you expect. Journal of the American College of Surgeons, 210(2), 228–231. 

https://pubmed.ncbi.nlm.nih.gov/20113944/

This group used an operationally definition of POI as discussed above. The 30-day readmission rate for this colorectal resection population was 14.6% with the major cause being onset of POI following hospital discharge.

Grass, F., Crippa, J., Lovely, J. K., Ansell, J., Behm, K. T., Achilli, P., Hübner, M., Kelley, S. R., Mathis, K. L., Dozois, E. J., & Larson, D. W. (2020). Readmissions Within 48 Hours of Discharge: Reasons, Risk Factors, and Potential Improvements. Diseases of the Colon and Rectum, 63(8), 1142–1150. 

https://pubmed.ncbi.nlm.nih.gov/32692075/

This detailed study of readmissions following colorectal surgery was carried out at the Mayo Clinic in Rochester, MN. All patients were cared for within an enhanced recovery program. 12.5% of patients were readmitted within 30 days of discharge. POI was the leading cause for early readmission in this population.

Merkow, R. P., Ju, M. H., Chung, J. W., Hall, B. L., Cohen, M. E., Williams, M. V., Tsai, T. C., Ko, C. Y., & Bilimoria, K. Y. (2015). Underlying reasons associated with hospital readmission following surgery in the United States. JAMA: The Journal of the American Medical Association, 313(5), 483–495. 

https://pubmed.ncbi.nlm.nih.gov/25647204/

This study highlights the major issue that POI plays in readmissions across a broad cross-section of surgical procedures. In this study, hospital readmission were examined in abdominal and non-abdominal surgical procedures using NSQIP data from 374 hospitals. POI was the 2nd leading cause of readmission for all patients (10.3%) and the first or second leading cause of readmission in bariatric, colorectal, hernia, and hysterectomy procedures.

Challenges of postoperative oral refeeding

Hui, V., Hyman, N., Viscomi, C., & Osler, T. (2013). Implementing a fast-track protocol for patients undergoing bowel resection: not so fast. American Journal of Surgery, 206(2), 152–158. 

https://pubmed.ncbi.nlm.nih.gov/23759698/

Blind application of early oral refeeding such as that used in ERAS protocols does not benefit all patients. This study highlights the challenges of implementing fast-track ERAS protocols in colorectal surgery and their unreliability for decreasing POI. 16.5% of patients treated under an ERAS pathway were readmitted vs 8% of those treated with conventional care. 21% of ERAS patients required NG insertion vs 9% of those getting conventional care.

Nazzani, S., Bandini, M., Preisser, F., Mazzone, E., Marchioni, M., Tian, Z., Stubinski, R., Clementi, M. C., Saad, F., Shariat, S. F., Montanari, E., Briganti, A., Carmignani, L., & Karakiewicz, P. I. (2019). Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis. Surgical Oncology, 28, 201–207. 

https://pubmed.ncbi.nlm.nih.gov/30851901/

This study challenges the assumption many have that the era of ERAS and fast-track protocols has solved the problem of POI. The authors evaluated outcomes for 10 oncologic surgical procedures over time using the Nationwide Inpatient Sample in over 3.4 million patients. Overall they found no change in POI rates over time and, in fact, saw increases in POI rates for colectomy, cystectomy, pancreatectomy, and gastrectomy.

Merkow, R. P., Ju, M. H., Chung, J. W., Hall, B. L., Cohen, M. E., Williams, M. V., Tsai, T. C., Ko, C. Y., & Bilimoria, K. Y. (2015). Underlying reasons associated with hospital readmission following surgery in the United States. JAMA: The Journal of the American Medical Association, 313(5), 483–495. 

https://pubmed.ncbi.nlm.nih.gov/25647204/

This study highlights the major issue that POI plays in readmissions across a broad cross-section of surgical procedures. In this study, hospital readmission were examined in abdominal and non-abdominal surgical procedures using NSQIP data from 374 hospitals. POI was the 2nd leading cause of readmission for all patients (10.3%) and the first or second leading cause of readmission in bariatric, colorectal, hernia, and hysterectomy procedures.