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Are right-sided colectomies for neoplastic disease at increased risk of primary postoperative ileus compared to left-sided colectomies? A coarsened exact matched analysis

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Abstract

Introduction

The objective of this study was to determine whether right-sided colectomies (RC) were associated with a higher incidence of primary postoperative ileus (pPOI) compared to left-sided colectomies (LC).

Methods

Patients who underwent elective colectomy for neoplastic disease between 2012 and 2016 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. RC and LC were defined as having an ileocolic or colocolic/colorectal anastomosis, respectively. Coarsened Exact Matching (CEM) was used to balance the two groups (1:1) on important confounders. The association between type of colectomy and pPOI, defined as POI in the absence of intra-abdominal sepsis, was then assessed in a multiple logistic regression analysis of the matched data.

Results

Of 40,636 patients who underwent a colectomy for neoplastic disease, 15,231 underwent a RC and 25,405 a LC. After CEM, 12,949 matched patients remained in each group, and all important confounders were well balanced. The incidence of pPOI was higher in the RC group (11.5% vs. 8.8%, p < 0.001). On multiple logistic regression, RC was associated with a 35% higher odds of develo** pPOI compared to LC (OR 1.35, 95% CI 1.25–1.47). RC was also associated with increased risk for NSQIP-defined major morbidity (OR 1.10, 95% CI 1.01–1.20), 30-day readmission (OR 1.16, 95% CI 1.06–1.27), and increased length of stay (β = 0.16 days, 95% CI 0.11–0.22).

Conclusion

pPOI is more common after RC than LC. Future research should aim at better understanding the pathophysiology behind this increased risk and identifying interventions to mitigate pPOI in this population.

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Acknowledgements

The authors thank Sarah Sabboobeh, Marie Demian, and Georgia Rigas for their administrative support and assistance.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada

    Richard Garfinkle, Faisal Al-Rashid, Nancy Morin, Gabriela Ghitulescu, Julio Faria, Carol-Ann Vasilevsky & Marylise Boutros

  2. Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada

    Marylise Boutros

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  1. Richard Garfinkle
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Correspondence to Marylise Boutros.

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Drs. Garfinkle, Al-Rashid, Morin, Ghitulescu, Faria, Vasilevksy, and Boutros have no conflicts of interest or financial ties to disclose.

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Garfinkle, R., Al-Rashid, F., Morin, N. et al. Are right-sided colectomies for neoplastic disease at increased risk of primary postoperative ileus compared to left-sided colectomies? A coarsened exact matched analysis. Surg Endosc 34, 5304–5311 (2020). https://doi.org/10.1007/s00464-019-07318-4

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