ObjectiveTo analyze the risk factors affecting the postoperative ileus after total gastrectomy in elderly patients with gastric cancer. MethodsThe elderly patients with gastric cancer after total gastrectomy admitted to the Second Department of General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2020 were retrospectively collected and the postoperative ileus was analyzed. Meanwhile the risk factors affecting the postoperative ileus after total gastrectomy in the elderly patients with gastric cancer were analyzed using univariate and multivariate logtistic regression analyses. ResultsA total of 306 elderly patients with gastric cancer who met the inclusion and exclusion criteria of this study were collected, 33 (10.8%) of whom suffered the postoperative ileus after surgery. The results of multivariate logtistic regression analysis showed that the preoperative anemia [OR (95%CI)=2.740 (1.181, 6.356), P=0.019], preoperative complicated intestinal obstruction [OR (95%CI)=3.286 (1.208, 8.935), P=0.020], open operation [OR (95%CI)=3.753 (1.298, 10.848), P=0.015], and operative time ≥400 min [OR (95%CI)=3.902 (1.705, 8.925), P=0.001] increased the risk probability of postoperative ileus after total gastrectomy in the elderly patients with gastric cancer. ConclusionsAccording to the analysis results of this study, the preoperative anemia and complicated intestinal obstruction, as well as the adopted open surgery and operation time ≥400 min are the risk factors of postoperative ileus in elderly patients with gastric cancer after total gastrectomy. When total gastrectomy is chosen for elderly patients with gastric cancer, preoperative physical status needs to be adjusted, such as correcting anemia and removing preoperative intestinal obstruction. During operation, the operation modus should be prior to the minimally invasive surgery according to the individual conditions of elderly patients and the operation skills of surgeons should be improved so as to reduce postoperative ileus.
Objective
To evaluate the association between intraoperative fluid management and prolonged postoperative ileus (PPOI) after colorectal surgery.
Methods
We reviewed the data of 980 patients who underwent elective colorectal surgery in West China Hospital of Sichuan University between July and December 2016. The primary outcome was PPOI. The association of intraoperative fluid volume and fluid balance with PPOI were analyzed.
Results
Nine hundred and eighty patients undergoing elective colorectal surgery were included, and the incidence of PPOI was 31.1% (305/980). Compared with non-PPOI patients, patients with PPOI had longer postoperative hospital stay and increased total hospital cost (P<0.05). Multivariate logistic regression analysis did not find intraoperative fluid volume and fluid balance were associated with PPOI in patients undergoing colorectal surgery (P>0.05).
Conclusions
There is no clinically relevant association between intraoperative fluid management and PPOI in adult patients underwent colorectal surgery. However, the occurrence of PPOI may prolong postoperative hospital stay and increase hospitalization cost.
Objective To identify the potential categories of postoperative ileus (POI) after transforaminal lumbar interbody fusion (TLIF) and their influencing factors, so as to provide references for developing targeted nursing strategies. Methods Patients who underwent TLIF in the Department of Orthopedics, Army Medical University between August 2023 and January 2024 were conveniently selected. Data on patients’ general information, medical history, and preoperative, intraoperative, and postoperative conditions were collected through questionnaires and medical record reviews. Latent class analysis was used to categorize the gastrointestinal symptoms of POI, and multinomial logistic regression was applied to analyze the influencing factors. Results A total of 435 patients were included. The gastrointestinal symptoms of POI were classified into three latent categories: high abdominal pain and bloating class (204 cases), high nausea and vomiting class (46 cases), and weak gastrointestinal response class (185 cases). Multinomial logistic regression analysis showed that history of gastric disease (P=0.006) and time to first postoperative anal exhaust (P<0.001) were influencing factors for patients presenting with high abdominal pain and bloating symptoms. History of gastric disease (P<0.001) and low postoperative hemoglobin level (P=0.008) were influencing factors for patients presenting with high nausea and vomiting symptoms. Conclusions POI after TLIF can be categorized into three types: high abdominal pain and bloating class, high nausea and vomiting class, and weak gastrointestinal response class. Nurses should pay attention to the impact of gastric disease history, anemia, and postoperative flatus time on gastrointestinal function, strive to shorten preoperative fasting time, protect gastric mucosa, strengthen perioperative blood management, and adopt multimodal approaches to promote the recovery of gastrointestinal motility, thereby reducing the incidence of POI after lumbar fusion surgery.
