Trajectory Of Gastrointestinal Function After Laparoscopic Colorectal Surgery Within An Enhanced Recovery Pathway
*Vivian Leung, *Nourah Alsharqawi, *Gabriele Baldini, *Sender Liberman, *Patrick Charlebois, *Barry Stein, *Julio F Fiore Jr, Liane S Feldman, Lawrence Lee
McGill University Health Centre, Montreal, QC, Canada
Objectives: Many patients remain hospitalized after colorectal surgery awaiting recovery of gastrointestinal(GI) function. Early identification of patients predicted to have uneventful GI recovery may allow for discharge prior to full return of GI function. Therefore, the objective of this study was to identify trajectories of GI recovery within a colorectal surgery enhanced recovery pathway(ERP).
Methods: Pooled data from two prospective studies enrolling adult patients undergoing elective laparoscopic colorectal resection at a specialist colorectal referral centre were analyzed(2013-2019). All patients were managed according to a mature ERP with a 3-day target length of stay(LOS). Postoperative GI symptoms were collected daily, and expressed using the validated I-FEED score(from 0-12, higher scores=worse GI function). Latent-class growth curve(trajectory) analysis was used to identify different I-FEED trajectories over the first 3 postoperative days(POD), and assign patients into these trajectory groups. Clinical outcomes were then compared between trajectory groups.
Results: A total of 192 patients had daily I-FEED scores and were included in this study (mean age 63.4 years(SD14.8), 56% male, 80% malignancy, and 18% new stoma). Trajectory analysis identified 3 distinct trajectories(Figure): trajectory 1 had no GI symptoms(41%); trajectory 2 had mild early symptoms with improvement over time(48%); and trajectory 3 had GI symptoms that significantly worsened between POD1-2(11%). I-FEED score ≤1 on POD1 predicted trajectory 1, and new stoma and inflammatory bowel disease were associated with trajectory 3. Trajectory 1 had fastest GI recovery, shortest LOS, and few complications, whereas trajectory 3 had the worst clinical outcomes(Table).
Conclusions: I-FEED trajectory over POD1-3 was associated with clinical outcomes and may be used to predict GI recovery. Patients with I-FEED score ≤1 on POD1(trajectory 1) had an uneventful return of GI function and postoperative course. Findings from this study may inform clinical decision making regarding early hospital discharge within colorectal ERPs.
|Group 1: no GI symptoms(n=79)||Group 2: Early GI symptoms with improvement (n=93)||Group 3: Worsening GI symptoms (n=20)||p-value|
|Mean Time to GI-3, days (SD)||1.4 (0.6)||1.6 (1.1)||2.6 (2.3)||<0.001|
|Need for NGT||1 (1%)||7 (8%)||15 (75%)||<0.001|
|In-hospital complications||5 (6%)||25 (26%)||15 (75%)||<0.001|
|Overall 30-day complications||11 (14%)||30 (32%)||19 (95%)||<0.001|
|Median LOS, days [IQR]||3 [2-3]||4 [3-4]||8 [7-12]||<0.001|
|Discharge within target LOS (3d)||66 (84%)||37 (40%)||0 (0%)||<0.001|
|30-day emergency room visit||9 (11%)||13 (14%)||2 (10%)||0.823|
|30-day readmission||7 (9%)||8 (9%)||1 (5%)||0.869|
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