QS216 - Ileus after colectomy in the modern era: a population-based analysis

Monday, May 12, 2025

1:20 PM – 1:23 PM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

Grace Crouch, Colon and Rectal Surgery Resident (Fellow)

Colon and Rectal Surgery Resident (Fellow)
Trinity Health Ann Arbor
Ann Arbor, MI, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SH

Samantha Hendren, MD, MPH, FACS, FASCRS

Professor of Surgery
Indiana University
Indianapolis, Indiana, United States

Disclosure information not submitted.
KB

Kara Brockhaus, PharmD

Perioperative Clinical Pharmacy Specialist
Trinity Health Ann Arbor
Ypsilanti, Michigan, United States

Disclosure information not submitted.
WW

Wenjing Weng, MS

Statistician
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.
JB

Jami Boyd, RN

Clinical Site Coordinator at Michigan Surgical Quality Collaborative
University of Michigan
Westland, Michigan, United States

Disclosure information not submitted.
CR

Cheryl Rocker, MSN, RN

RN
Michigan Surgical Quality Collaborative
Ann Arbor, Michigan, United States

Disclosure information not submitted.

Senior Author(s)

Robert K. Cleary, MD

Program Director Colon and Rectal Surgery
Trinity Health Ann Arbor
Trinity Health
Ann Arbor, Michigan, United States

All of the relevant financial relationships listed below have been mitigated.
Intuitive Surgical, Inc: Honoraria (Ongoing)

All of the relevant financial relationships listed below have been mitigated.

Grace Crouch, Colon and Rectal Surgery Resident (Fellow): This individual has no financial relationships with ineligible companies.

Robert K. Cleary, MD: Intuitive Surgical, Inc: Honoraria (Ongoing)

Image or Table (Do Not add text here):

Purpose/Background: Postoperative ileus (POI) after colectomy is common and is associated with increased healthcare costs and patient morbidity. While most hospitals in Michigan have implemented enhanced recovery pathways, we hypothesized that ileus would still be a common occurrence, and our goal was to understand the current burden of, and risk factors for POI.

Methods/Interventions: This is a population-based study of patients from 70 hospitals in the Michigan Surgical Quality Collaborative undergoing elective colectomy between 2018 and 2023. The primary outcome was ileus defined as “no oral intake ≥4 postoperative days or the need for nasogastric tube insertion within 30 days after surgery”. Patient, hospital, perioperative care, and surgical risk factors were tested for association with POI. Multivariable logistic regression was performed to identify independent risk factors for ileus. Hospital rates were compared.

Results/Outcomes: Of 9,571 patients who underwent elective colectomy, there were 9,393 segmental and 178 total colectomies. Ileus was diagnosed in 6.56% of the cohort, and hospital crude rates ranged from 0.79% to 22.0%. Patients with ileus had a significantly longer length of hospital stay (median 8.03 days versus 3.09, p< 0.0001). Ileus was associated with increased risk for other adverse outcomes, including complications (29.62% vs 7.68%, p< 0.0001), mortality (1.75% vs 0.59%, p=0.0006), reoperation (16.72% vs 4.92%, p< 0.0001), and readmissions (27.39% vs 6.50%, p< 0.0001).

Multivariable analysis showed that the most powerful predictor of ileus was total (27.5%) versus segmental (6.2%) colectomy. Other independent risk factors in decreasing order of magnitude were hospital size >500 beds, male sex, non-white race, and age >65 years. Factors associated with decreased ileus included minimally-invasive (5.2%) versus open (10.1%) surgical approach, alvimopan, and ambulation within 24 postoperative hours. There was significant hospital variation in ileus rates.

Conclusion/Discussion: The low observed rate of ileus likely reflects the modern era of enhanced recovery and minimally-invasive colectomy. Total colectomy is associated with a high rate of ileus compared to segmental colectomy. Increased implementation of minimally-invasive surgery, perioperative alvimopan, and early ambulation might further reduce ileus rates.