Delayed Return of Gastrointestinal Function after Hepatectomy: A Single-Center Cross-Sectional Study

Abstract

Abstract Background Hepatectomy remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. Aims This study aimed to assess DRGF predictors after hepatectomy. Methods This study included all consecutive adult patients undergoing hepatectomy between 01/2010 and 12/2019. DRGF was defined as need of postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression. Results A total of 502 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n=14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery After Surgery implementation (16/78=21% vs. 66/423=16%, p=0.281). DRGF was more frequent after major hepatectomy (55/239=23% vs. 27/263=10%, p<0.001). DRGF occurred more frequently in patients with preoperative embolization (26/88=30% vs. 55/407=14%, p<0.001), biliary anastomosis (20/48=42% vs. 61/450=14%, p<0.001), and extrahepatic resection (37/108=34% vs. 45/393=11%, p<0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min., p<0.001) and higher median blood loss (1088 vs. 701 mL, p<0.001). DRGF patients developed more pneumonias (14/22=64% vs. 8/22=36%, p<0.001) and had longer median length of stay (19 vs. 8 days, p<0.001). On multivariable analysis, operation duration (OR 1, 95%CI 1.002-1.008, p<0.001) and postoperative biloma/biliary leak (OR 3.3, 95%CI 1.8-7.7, p<0.001) were independently associated with DRGF occurrence. Conclusions Postoperative DRGF occurred in 16% of the patients and was associated with longer length of stay. Surgery duration and postoperative biloma/biliary leak were found as independent predictors of DRGF.