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A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus.

Published on May 1, 2005in Colorectal Disease2.997
· DOI :10.1111/j.1463-1318.2005.00763.x
Henrik Kehlet107
Estimated H-index: 107
,
Russell Williamson4
Estimated H-index: 4
(GSK: GlaxoSmithKline)
+ 1 AuthorsRobert W. Beart70
Estimated H-index: 70
(SC: University of Southern California)
Abstract
Objective  Postoperative ileus (POI) can negatively affect patient recovery and morbidity, yet the lack of an internationally accepted definition and clinical management pathway for this condition suggest POI may be under-recognized as a clinical problem. The purpose of this survey was therefore to assess current attitudes of surgeons towards the clinical impact and management of POI. Subjects and methods  Telephone interviews were conducted with 230 surgeons from hospitals in the UK, France, Germany, Italy and Spain. Results  Across Europe, there are differences in the terms surgeons use to refer to delayed recovery of gastrointestinal (GI) function and the symptoms, concerns and risks they associate with this condition. Furthermore, there is marked variation in the attitudes of European surgeons towards minimizing the risk of delayed recovery of GI function and in the strategies to manage POI. Additionally, some of the measures applied most commonly by European surgeons are in contrast to evidence in the literature indicating that they have no benefit for quicker resolution of GI function. Conclusion  The results suggest that there is a need for clearer definition of the factors that constitute POI, increased recognition of the impact of this condition and improved understanding of the most effective peri-/postoperative care for surgical patients.
  • References (16)
  • Citations (35)
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References16
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#1Peer Wille-Jørgensen (UNIFESP: Federal University of São Paulo)H-Index: 31
Last. Delcio MatosH-Index: 21
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PURPOSE: This study was designed to establish scientific evidence for and clinical results of preoperative mechanical bowel cleansing before elective colorectal surgery. METHODS: Systematic literature searches in electronic databases, conference proceedings, and hand searches of reference lists of previously retrieved literature without any language restrictions were used. Only randomized trials were included. A quality assessment of each retrieved trial was performed. Outcome measures were surg...
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#1Andrew LuckeyH-Index: 7
Last. Yvette TachéH-Index: 71
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Objective To review the pathogenesis and treatment of postoperative ileus. Data Sources Data collected for this review were identified from a MEDLINE database search of the English-language literature. The exact indexing terms were "postoperative ileus," "treatment," "etiology," and "pathophysiology." Previous review articles and pertinent references from those articles were also used. Study Selection All relevant studies were included. Only articles that were case presentations or that mentione...
285 CitationsSource
#1Timothy G. Schuster (UM: University of Michigan)H-Index: 23
#2James E. Montie (UM: University of Michigan)H-Index: 66
Despite significant advancements in the care of the surgical patient, little progress has been made in the understanding and treatment of postoperative ileus (PI). Cystectomy with urinary diversion and complex urinary tract reconstruction using bowel are procedures in urologic surgery associated with some of the greatest hospital costs and longest lengths of stay (LOS). Improvements in costs, patient satisfaction, and complication rates often accompany the institution of “care pathways” designed...
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Abstract Postoperative ileus (POI) is an inevitable adverse consequence of surgical procedures. In fact, prolonged POI can lead to patient discomfort, decreased mobility, delayed enteral feeding, and ultimately, prolonged hospitalizations and increased costs. It is believed that POI occurs as a result of inhibitory neural reflexes and inflammatory processes. The use of postoperative opioids also appears to contribute to ileus. Recently, the potential influence of endogenous opioids, in addition ...
278 CitationsSource
#1Stephen LewisH-Index: 24
#2Matthias EggerH-Index: 137
Last. Steve ThomasH-Index: 36
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Abstract Objective: To determine whether a period of starvation (nil by mouth) after gastrointestinal surgery is beneficial in terms of specific outcomes. Design: Systematic review and meta-analysis of randomised controlled trials comparing any type of enteral feeding started within 24 hours after surgery with nil by mouth management in elective gastrointestinal surgery. Three electronic databases (PubMed, Embase, and the Cochrane controlled trials register) were searched, reference lists checke...
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#2Neeru Sharma (WashU: Washington University in St. Louis)H-Index: 6
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Background Postoperative recovery of gastrointestinal function and resumption of oral intake are critical determinants of the length of hospital stay. Although opioids are effective treatments for postoperative pain, they contribute to the delayed recovery of gastrointestinal function. Methods We studied the effects of ADL 8-2698, an investigational opioid antagonist with limited oral absorption that does not readily cross the blood–brain barrier, on postoperative gastrointestinal function and t...
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#1Tammy J. Bungard (U of A: University of Alberta)H-Index: 15
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Metoclopramide, cisapride, and erythromycin are commonly administered to reduce the duration of postoperative ileus (POI). As these agents are not without potential adverse effects, their efficacy in shortening the duration of POI should be evaluated. The etiology of POI is not well understood and therefore the precise treatment is unclear. Nasogastric suction is the mainstay of therapy, and management of fluid and electrolyte imbalances is crucial. The role of prokinetic agents is less understo...
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Last. J. M. Müller (HSU: Humboldt State University)H-Index: 12
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Background: A shorter duration of postoperative ileus and earlier oral alimentation of patients may be a clinically relevant benefit of laparoscopic compared with conventional colorectal resection. Patients/Methods: A total of 60 patients were randomised to either laparoscopic (n=30) or conventional (n=30) resection of colorectal tumours. Major endpoints were the postoperative time to the first bowel movement and the time until oral feeding without parenteral alimentation was tolerated. Minor en...
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#1B. T. Stewart (St. Vincent's Health System)H-Index: 1
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Background: A period of starvation after colorectal resections to allow for resolution of the clinical evidence of ileus has been an unchallenged surgical doctrine until recent times. A prospective randomized trial comparing early feeding to traditional management in patients undergoing open elective colorectal resections is reported. Methods: Patients undergoing elective intraperitoneal colorectal resections without stoma formation were randomized to either an early feeding or control group. Th...
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PURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification. METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients w...
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Summary Postoperative ileus (POI) is a major focus of concern for surgeons because it increases duration of hospitalization, cost of care, and postoperative morbidity. The definition of POI is relatively consensual albeit with a variable definition of interval to resolution ranging from 2 to 7 days for different authors. This variation, however, leads to non-reproducibility of studies and difficulties in interpreting the results. Certain risk factors for POI, such as male gender, advanced age an...
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