Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis

World J Surg. 2020 Mar;44(3):957-966. doi: 10.1007/s00268-019-05278-3.


Background: Defining severe postoperative ileus in terms of consequences could help physicians standardize the management of this condition. The recently described classification based on consequences requires further investigation. The aim of this study was to obtain a snapshot of postoperative ileus in patients undergoing colorectal surgery within enhanced recovery programs and to identify factors associated with non-severe and severe postoperative ileus.

Methods: This prospective registry data analysis was conducted in 40 centers in five different countries. A total of 786 patients scheduled for colorectal surgery within enhanced recovery programs were included. The primary endpoint was the incidence rate of postoperative ileus as defined by Vather et al. RESULTS: A total of 121 patients experienced postoperative ileus (15.4%). Non-severe POI occurred in 48 patients (6.1%), and severe postoperative ileus occurred in 73 patients (9.3%). In multivariate analysis, the male gender and intra-abdominal complications were associated with severe postoperative ileus: odd ratio (OR) = 2.03 [95% confidence interval (CI) 1.14-3.59], p = 0.01 and OR = 3.60 [95% CI 1.75-7.40], p < 0.0001, respectively. Conversely, open laparotomy and urinary retention were associated with non-severe POI: OR = 3.03 [95% CI 1.37-6.72], p = 0.006 and OR = 2.70 [95% CI 0.89-8.23], p = 0.08, respectively.

Conclusions: Postoperative ileus occurred in 15% of patients after colorectal surgery within enhanced recovery programs. For 60% of patients, this was considered severe. The physiopathology of these two entities could be different, severe POI being linked to intraabdominal complication, while non-severe POI being linked with risk factors for "primary" POI. The physician should pay attention to male patients having POI after colorectal surgery and look for features evocating intraabdominal complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colon / surgery*
  • Digestive System Surgical Procedures / adverse effects
  • Enhanced Recovery After Surgery
  • Female
  • Humans
  • Ileus / epidemiology*
  • Ileus / etiology
  • Incidence
  • Male
  • Middle Aged
  • Patient Acuity
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Rectum / surgery*
  • Registries
  • Risk Factors
  • Sex Factors
  • Urinary Retention / epidemiology