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Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort.
Am Surg 2017; 83(6):564-572AS

Abstract

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.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

28637557

Citation

Rencuzogullari, Ahmet, et al. "Nomogram-Derived Prediction of Postoperative Ileus After Colectomy: an Assessment From Nationwide Procedure-Targeted Cohort." The American Surgeon, vol. 83, no. 6, 2017, pp. 564-572.
Rencuzogullari A, Benlice C, Costedio M, et al. Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort. Am Surg. 2017;83(6):564-572.
Rencuzogullari, A., Benlice, C., Costedio, M., Remzi, F. H., & Gorgun, E. (2017). Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort. The American Surgeon, 83(6), pp. 564-572.
Rencuzogullari A, et al. Nomogram-Derived Prediction of Postoperative Ileus After Colectomy: an Assessment From Nationwide Procedure-Targeted Cohort. Am Surg. 2017 Jun 1;83(6):564-572. PubMed PMID: 28637557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort. AU - Rencuzogullari,Ahmet, AU - Benlice,Cigdem, AU - Costedio,Meagan, AU - Remzi,Feza H, AU - Gorgun,Emre, PY - 2017/6/23/entrez PY - 2017/6/24/pubmed PY - 2017/11/7/medline SP - 564 EP - 572 JF - The American surgeon JO - Am Surg VL - 83 IS - 6 N2 - 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. SN - 1555-9823 UR - https://www.unboundmedicine.com/medline/citation/28637557/Nomogram_Derived_Prediction_of_Postoperative_Ileus_after_Colectomy:_An_Assessment_from_Nationwide_Procedure_Targeted_Cohort_ L2 - https://www.ingentaconnect.com/openurl?genre=article&amp;issn=0003-1348&amp;volume=83&amp;issue=6&amp;spage=564&amp;aulast=Rencuzogullari DB - PRIME DP - Unbound Medicine ER -