A characterisation of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score
- Correspondence to: Annette Bisanz
26 Grants Lake Circle, Sugar Land, TX 77479, USA;
List the implications for nursing practice of this research
▪ Allows the identification of patients at risk for postoperative ileus (POI).
▪ Predictive information combined with evidence from the WHO provides guidelines to prevent POI.
▪ Improved preventive care can decrease the cost and length of hospital stays.
▪ Nurses can advocate for preventive measures even though they do not have prescriptive authority.
List the implications for nursing research in the light of this study
▪ Nurses can translate this information into their standard of care.
▪ Inspires nurses to get involved in the research process in order to contribute to the solution of POI.
The aim of Kronberg's study was to investigate preoperative, intraoperative and postoperative risk factors associated with the development of POI in patients having a laparascopic partial colectomy. POI is documented as causing prolonged hospital stay and increased healthcare cost.1
Kronberg and colleagues retrospectively identified 413 patients who had had a laparoscopic segmental colectomy between 2004 and 2008. Clinical, metabolic and pharmacological data were obtained from a prospectively maintained database. Associations between likelihood of POI and study variables including preoperative albumen, postoperative haemoglobin, potassium, calcium, magnesium, deep vein thrombosis along with age, chronic use of opioids and previous abdominal surgery were studied. Each was assessed univariately using χ2 tests, Fisher exact tests and logistic regression models. A scoring system for prediction of POI was constructed using a multivariate logistic regression model based on forward stepwise selection of preoperative factors.
The author stated that there are some reports of a quicker return of intestinal function in patients operated by laparoscopy, but his study showed that 10% of his study group developed POI with laparoscopy surgery. Of 413 patients, 42 developed POI. Three parameters (age >60, preoperative long-term use of opioids and previous abdominal surgery) were identified as independent predictive variables. Patients with two or more of these risk factors had six times the risk of developing POI.
The strength of this study is that it lays the groundwork for the development of a predictive model for identifying patients at risk for POI. The WHO identifies treatment modalities used to prevent POI with a corresponding level of evidence for their effectiveness.2 3 The WHO classifies these treatments as being beneficial, modestly beneficial, possibly beneficial, probably beneficial, may be beneficial or not beneficial.2
Combining this information with Kronberg's predictive score has implications for decreasing the percentage of patients developing POI. This predictive score could be incorporated into the assessment of preoperative patients along with suggestions from the WHO's evidence-based analysis. A replication of the study by Kronberg and colleagues in a prospective study in a larger population, with multiple types of surgeries, would help validate the predictive scoring.
The medication profile of the patient is not mentioned in the present study. Antidepressants, antipsychotics and mood stabilisers may cause anticholinergic side effects leading to POI.4 As many patients are on these types of medications, Luzny and colleagues raised the question of whether the newer generation drugs would cause fewer anticholinergic side effects and thus decrease POI. The use of alvimopan and/or methylnaltrexone to prevent POI is well documented in the literature as contributing to a decrease in POI.3 Other agents which hold promise in the treatment of POI include atilmotin and lubiprostone.3 It may be helpful to include the use of medications in future predictive studies.