Risk factors for postoperative ileus in elective colorectal
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Postoperative ileus is a common and costly complication after elective colorectal surgery. Male sex, ostomy, infection, and intravenous fluids are associated with an increased risk of postoperative ileus in elective colorectal surgery.

Researchers aimed to investigate the impact of intestinal reconstruction and intravenous fluid on ileus and renal function after colorectal resection under an enhanced recovery protocol.

A retrospective study was reviewed, analyzing elective colorectal resections performed under enhanced recovery protocol. Postoperative ileus was defined as nasogastric decompression, nil per os >3 days postoperatively, or nasogastric tube insertion. Patients with and without ileus were compared. Intravenous fluid and different anastomoses and ostomies were investigated. Acute kidney injury was a secondary outcome, due to the potential of renal damage with restriction of intravenous fluid volume during and after surgery and controversy in current literature in this matter.

- Postoperative ileus occurred in 18.5% of patients. Male sex and postoperative infection were associated with ileus.

- Compared to the colorectal anastomosis, ileostomy/ileorectal anastomosis had the highest risk of ileus, colostomy second highest, while ileocolic anastomosis did not significantly differ on multivariate analysis.

- Each liter of intravenous fluid within the first 72 hours significantly correlated with postoperative ileus. Rates of acute kidney injury did not differ.

Source: each additional liter of intravenous fluid given in the first 72 hours increased the risk of postoperative ileus 1.4-fold. There is a substantially higher risk of ileus with male sex, infection, ileostomy/ileorectal anastomosis, and colostomy.

Source: https://doi.org/10.1016/j.surg.2021.05.035