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Session: ePoster: Colon, Colorectal and Rectal Cancer (Sun225)

EP512 - Ileus after robotic colectomy: A single institution comparison in enhanced recovery

Sunday, May 11, 2025
2:30 PM – 2:35 PM PT
Location: Monitor 7, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Erin Sheehan, MD

    General Surgery Resident
    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)

  • KB

    Kara Brockhaus, PharmD

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

    Disclosure information not submitted.

  • MH

    Marianne Huebner, PhD

    Statistician
    Department of Statistics and Probability
    East Lansing, Michigan, United States

    Disclosure information not submitted.

  • NK

    Nivya Kolli, PharmD MS PhD

    Project Manager Academic Research
    Trinity Health Ann Arbor
    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

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Erin Sheehan, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Postoperative ileus (POI) after colorectal surgery is associated with prolonged hospital length of stay, readmission, and higher costs of care. POI may be unpredictable and even uncomplicated enhanced recovery elective minimally invasive colorectal operations may be complicated by ileus and readmission related to ileus.

Interventions designed to decrease ileus depend on identifying modifiable risk factors. The aim of this study was to identify factors associated with ileus after robotic segmental colectomy.

Methods/Interventions: This is a single institution retrospective analysis of enhanced recovery robotic right and left colectomy in a prospectively maintained institutional colorectal surgery database from 1/1/2018 through 7/31/2024. The primary outcome was postoperative ileus. Firth’s bias-reduced logistic regression was used to test the association of postoperative opioid usage and comorbidities with the occurrence of ileus.

Results/Outcomes: 411 left and 403 right colectomies met inclusion criteria. Neoplasia was the operative diagnosis for 88.2% of right colectomies and diverticular disease for 77.9% of left colectomies (p < 0.001). Median postoperative hospital length of stay was 2.0 days and did not change over time. Ileus occurred in 5.9% of the patient population. Bivariate comparison of patients with and without ileus showed that older age (p=0.036), male sex (p=0.009), and postoperative intravenous opioids (p < 0.001) were associated with ileus. Multivariate analysis confirmed that ileus was significantly associated with older age (OR 1.04, CI 1.01-1.07, p=0.005) and male sex (OR 2.67, CI 1.41-5.07, p=0.003). In addition, ileus was significantly associated with postoperative opioids (intravenous or oral, OR 3.12, CI 1.17-8.34, p=0.013). Alvimopan (p=0.107) and TAP blocks (p=0.257) were not associated with decreased ileus. There was no significant difference in ileus between right and left colectomy (p=0.422).

Conclusion/Discussion: Postoperative opioids were the only modifiable risk factor for ileus after robotic segmental colectomy. Increasing emphasis on opioid-sparing and other targeted enhanced recovery pathway options should focus on further decreasing the incidence of this vexing postoperative complication.