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Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort

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Postoperative ileus (POI) is a clinical burden to health-care system. This study aims to evaluate the incidence and predictors of POI in patients undergoing colectomy and create a nomogram by using recently released procedure-targeted nationwide database. Patients who underwent elective colectomy in 2012 and 2013 were identified from American College of Surgeons National Surgical Quality Improvement Program using the new procedure-targeted database. Demographics, comorbidities, and 30-day postoperative outcomes were evaluated. Variables in the final stepwise multiple logistic regression model for each outcome were selected in a stepwise fashion using Akaike’s information criterion. A nomogram was created to aid in the calculation of POI risk for individual patients. A total of 29,201 patients met the inclusion criteria; 3834 (13.1%) developed POI with a male predominance (55.9%). Patients who developed ileus had longer length of hospital stay (11 vs 5 days; P < 0.001) and operative time (200 vs 174 minutes; P < 0.001). In the stepwise logistic regression model, the following variables were found to be independent risk factors for POI: older age (P < 0.001), male gender (P < 0.001), American Society of Anesthesiologists class III/IV (P < 0.001), open approach (P < 0.001), preoperative septic conditions (P < 0.001), omission of oral antibiotic before surgery (P < 0.001), right colectomy or total colectomy vs other procedures (P < 0.001), smoking (P = 0.001), decreased preoperative serum albumin level (P < 0.001), and prolonged operating time (P < 0.001). All postoperative complications were more frequently occurred in patients with POI. The nomogram accurately predicted POI with a concordant index for this model of 0.69. The use of minimal invasive techniques, control of preoperative septic conditions, oral antibiotic bowel preparation and shorter operative time are associated with a decreased rate of POI. External validation is essential for the confirmation and further evaluation of our logistic regression model and nomogram.
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Document Type: Research Article

Publication date: June 1, 2017

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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