Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis

Sebastiano Nazzani, Marco Bandini, Felix Preisser, Elio Mazzone, Michele Marchioni, Zhe Tian, Robert Stubinski, Maria Chiara Clementi, Fred Saad, Shahrokh F. Shariat, Emanuele Montanari, Alberto Briganti, Luca Carmignani, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. Methods: Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. Results: Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. Conclusions: Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.

Original languageEnglish
Pages (from-to)201-207
Number of pages7
JournalSurgical Oncology
Volume28
DOIs
Publication statusPublished - Mar 1 2019

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Intestinal Pseudo-Obstruction
Population
Mastectomy
Length of Stay
Hospital Charges
Cystectomy
Colectomy
Logistic Models
Ovariectomy
Prostatectomy
Linear Models
Regression Analysis
Lung
Pancreatectomy
Gastrectomy
Nephrectomy
Hysterectomy

Keywords

  • Enhanced recovery after surgery
  • Ileus
  • Length of stay
  • Major surgical oncological procedure
  • Nationwide Inpatient Sample

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era : A population based analysis. / Nazzani, Sebastiano; Bandini, Marco; Preisser, Felix; Mazzone, Elio; Marchioni, Michele; Tian, Zhe; Stubinski, Robert; Clementi, Maria Chiara; Saad, Fred; Shariat, Shahrokh F.; Montanari, Emanuele; Briganti, Alberto; Carmignani, Luca; Karakiewicz, Pierre I.

In: Surgical Oncology, Vol. 28, 01.03.2019, p. 201-207.

Research output: Contribution to journalArticle

Nazzani, S, Bandini, M, Preisser, F, Mazzone, E, Marchioni, M, Tian, Z, Stubinski, R, Clementi, MC, Saad, F, Shariat, SF, Montanari, E, Briganti, A, Carmignani, L & Karakiewicz, PI 2019, 'Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis', Surgical Oncology, vol. 28, pp. 201-207. https://doi.org/10.1016/j.suronc.2019.01.011
Nazzani, Sebastiano ; Bandini, Marco ; Preisser, Felix ; Mazzone, Elio ; Marchioni, Michele ; Tian, Zhe ; Stubinski, Robert ; Clementi, Maria Chiara ; Saad, Fred ; Shariat, Shahrokh F. ; Montanari, Emanuele ; Briganti, Alberto ; Carmignani, Luca ; Karakiewicz, Pierre I. / Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era : A population based analysis. In: Surgical Oncology. 2019 ; Vol. 28. pp. 201-207.
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abstract = "Background: Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. Methods: Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. Results: Paralytic ileus rates ranged from 0.1{\%} (mastectomy) to 23.2{\%} (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1{\%}, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1{\%}) and colectomy (PP: 17.15{\%}) and were lowest for lung resection (PP: 2.22{\%}) and mastectomy (PP: 0.16{\%}). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. Conclusions: Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.",
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T1 - Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era

T2 - A population based analysis

AU - Nazzani, Sebastiano

AU - Bandini, Marco

AU - Preisser, Felix

AU - Mazzone, Elio

AU - Marchioni, Michele

AU - Tian, Zhe

AU - Stubinski, Robert

AU - Clementi, Maria Chiara

AU - Saad, Fred

AU - Shariat, Shahrokh F.

AU - Montanari, Emanuele

AU - Briganti, Alberto

AU - Carmignani, Luca

AU - Karakiewicz, Pierre I.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. Methods: Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. Results: Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. Conclusions: Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.

AB - Background: Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. Methods: Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. Results: Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. Conclusions: Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.

KW - Enhanced recovery after surgery

KW - Ileus

KW - Length of stay

KW - Major surgical oncological procedure

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