Multicentre observational study of gastrointestinal recovery after elective colorectal surgery

被引：16

作者：

Chapman, S. J.

Tahir, W.

Bolton, W.

Pericleous, A.

Saeed, F.

Sheikh, S.

Silva, A. N.

Maslekar, S.

Jayne, D. G.

Altunel, M. ^{[1
]}

Hirst, N. A. ^{[2
]}

Khan, A. ^{[1
,3
,7
]}

Ashmore, D. ^{[4
]}

Wilkins, A. ^{[5
]}

Wong, C. ^{[6
]}

Edwards, C. S. ^{[6
]}

Nduka, A. ^{[7
]}

Richards, E. R. ^{[8
]}

Mori, G. ^{[9
]}

Ali, H. ^{[1
]}

Amin, I. ^{[1
]}

Athanasiou, C. ^{[1
]}

Farooq, M. ^{[1
]}

Hardie, C. ^{[1
]}

Khan, A. ^{[1
,3
,7
]}

Khan, U. ^{[1
]}

O'Neill, C. ^{[1
]}

Sturgess, G. ^{[1
]}

Ebbitt, G. ^{[2
]}

Wells, D. ^{[2
]}

Sakellaropoulos, S. ^{[3
]}

Asmar, S. ^{[4
]}

Friend, C. ^{[5
]}

Habib, S. ^{[5
]}

Jarral, F. ^{[5
]}

Phillips, M. E. ^{[5
]}

Suhail, A. ^{[5
]}

Young, R. S. ^{[5
]}

Dykes, G. ^{[6
]}

Gissing, S. ^{[6
]}

Thomas, B. ^{[6
]}

Khan, A. ^{[1
,3
,7
]}

Mercer, C. ^{[7
]}

Wellby, G. ^{[7
]}

Jackson, A. ^{[8
]}

Singh, S. ^{[8
]}

Flynn, L. ^{[10
]}

Jones, K. Lloyd ^{[10
]}

Parkash, A. ^{[10
]}

Simpson, L. J. ^{[10
]}

机构：

[1] Bradford Royal Infirm, Bradford, W Yorkshire, England

[2] Dewsbury & Dist Hosp, Dewsbury, England

[3] Doncaster Royal Infirm, Doncaster, England

[4] Huddersfield Royal Infirm, Huddersfield, W Yorkshire, England

[5] Hull & East Yorkshire NHS Trust, Castle Hill Hosp, Kingston Upon Hull, N Humberside, England

[6] Pinderfields Gen Hosp, Wakefield, England

[7] Scarborough Gen Hosp, Scarborough, ON, Canada

[8] Scunthorpe Gen Hosp, Scunthorpe, England

[9] York Hosp, York, N Yorkshire, England

[10] St James Univ Hosp, Leeds, W Yorkshire, England

来源：

COLORECTAL DISEASE | 2018年 / 20卷 / 06期

关键词：

Colorectal surgery; gastrointestinal transit; postoperative ileus; POSTOPERATIVE ILEUS; RESEARCH COLLABORATIVES; ENHANCED RECOVERY; GUIDELINES;

D O I：

10.1111/codi.13949

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

AimPostoperative ileus (POI) is characterised by delayed gastrointestinal recovery and is common after colorectal surgery. Numerous strategies to optimise POI have been proposed but its management remains an unmet clinical need. This study aimed to characterise the duration and management of gastrointestinal recovery in patients undergoing elective colorectal surgery. MethodA snapshot, prospective, observational study was undertaken between November 2016 and January 2017 at 10 regional hospitals in the United Kingdom. Adult patients undergoing elective colorectal surgery with resection of bowel or reversal of stoma were included. Outcomes included time until return of gastrointestinal function, timing of nasogastric tube (NGT) insertion, uptake of targeted interventions and clinical outcomes. Data were validated for accuracy by independent investigators. Results204 patients met the eligibility criteria. The median time for gastrointestinal recovery was 3days (IQR 2-4); right-sided resections were associated with longer gastrointestinal recovery than left sided (4days (2.75-5.25) vs 3days (2-4); P=0.002). The rate of NGT insertion was 22.5% at a median time of 4 (4-4.75)days. NGT insertion after vomiting was associated with a higher incidence of bronchopneumonia compared to early placement (13.3% vs 29.0%). Targeted interventions, such as chewing gum (4.4%), selective mu-receptor antagonists (1.0%) and pro-kinetic agents (13.7%) were infrequently used. ConclusionThe average time to gastrointestinal recovery after elective colorectal surgery was three days. Late NGT insertion was associated with an increased incidence of bronchopneumonia. The clinical uptake of targeted interventions to improve gastrointestinal recovery was poor.

引用

页码：536 / 544

页数：9

共 25 条

[1] Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications [J].