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K Grosh, S Shebrain, RG Sawyer
Western Michigan University

Post-operative ileus is associated with significant morbidity. We hypothesized that colorectal procedures and anastomosis creation would be associated with ileus.

Data from the Michigan Surgical Quality Collaborative database of patients who underwent major small bowel, colorectal, or gynecological operations from 2014 to 2019 were analyzed. The primary outcome was the development of post-operative ileus requiring return to nil per os (NPO) status or nasogastric tube placement. Pre-operative variables were analyzed in an attempt to identify patients who might benefit from pre-emptive interventions. Patient demographics and outcomes were compared by univariate analysis using Student’s t-test and Chi-square analysis. Logistic regression was used to determine pre-operative factors independently associated with post-operative ileus.

A total of 70,423 cases were included, with 1342 complicated by post-operative ileus (1.9%). The procedures most common in the analysis included laparoscopic hysterectomy (n=19388, 27.5%), abdominal hysterectomy (n=6191, 8.8%), and laparoscopic colectomy with anastomosis (n=5773, 8.2%). Patient demographics are given in Table 1. Independent risk factors for ileus by logistic regression included increasing age (OR = 1.01, 95% CI = 1.00-1.01), increasing ASA score (OR = 1.21, 95% CI = 1.12-1.32), and open procedures (OR = 2.16, 95% CI = 1.87-2.50). Ileus was less common in females (OR = 0.66, 95% CI = 0.59-0.75), and after gynecological procedures (OR = 0.13, 95% CI = 0.09-0.20). Overall C statistic/ROC AUC was 0.77. Neither anastomosis nor pre-operative alvimopan affected occurrence of ileus. Ileus was associated with a significantly longer hospital length of stay (13.7 ± 8.7 days vs 4.7 ± 8.5 days, p <0.001) and 30-day mortality (4.5% vs 2.3%, p <0.001).

Ileus is most likely to occur in older patients with high ASA scores undergoing open small bowel procedures. These patients are likely the most appropriate candidates for alvimopan or other interventions to avoid ileus.

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