Does enhanced recovery reduce postoperative ileus after colorectal surgery?

Abstract

While enhanced recovery after surgery (ERAS) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay, its impact on recovery of bowel motility is poorly documented. The aims of this study were to assess the impact of ERAS on bowel motility recovery, and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature. This is a single-center prospective observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17months. Global resumption of intestinal transit (GROT) was defined as passage of stool combined with alimentary tolerance of solid food. One hundred and thirty-one patients were included. A median of 14items (range: 13-16) was complied out of 19 observable items in the protocol. Median time to passage of flatus (MTPF) was 2days and the GROT was 3days. The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased (respectively P<0.001, r2=0.11 and P=0.04, r2=0.06). The incidence of postoperative "ileus" varied from 1.5% to 61.8% depending on the interval chosen to define ileus (cut-off from 1 to 7days). Adherence to≥85% of the items in the ERAS protocol protected patients from "prolonged ileus", i.e., lasting≥4days (OR=0.35; 95% CI=0.15 to 0.83). The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT. There is a need for a consensual definition of postoperative ileus.