Comparison of recovery and outcome after left and right colectomy

F. Grass, J. K. Lovely, J. Crippa, J. Ansell, M. Hübner, K. L. Mathis, David Larson

Research output: Contribution to journalArticle

Abstract

Aim: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results: In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion: Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.

Original languageEnglish (US)
JournalColorectal Disease
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Colectomy
Ileus
Crohn Disease
Demography
Compliance
Weight Gain
Colon
Body Mass Index
Databases
Neoplasms

Keywords

  • colectomy
  • Crohn's
  • Enhanced recovery
  • ileus
  • outcome

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Grass, F., Lovely, J. K., Crippa, J., Ansell, J., Hübner, M., Mathis, K. L., & Larson, D. (Accepted/In press). Comparison of recovery and outcome after left and right colectomy. Colorectal Disease. https://doi.org/10.1111/codi.14543

Comparison of recovery and outcome after left and right colectomy. / Grass, F.; Lovely, J. K.; Crippa, J.; Ansell, J.; Hübner, M.; Mathis, K. L.; Larson, David.

In: Colorectal Disease, 01.01.2019.

Research output: Contribution to journalArticle

Grass F, Lovely JK, Crippa J, Ansell J, Hübner M, Mathis KL et al. Comparison of recovery and outcome after left and right colectomy. Colorectal Disease. 2019 Jan 1. https://doi.org/10.1111/codi.14543
Grass, F. ; Lovely, J. K. ; Crippa, J. ; Ansell, J. ; Hübner, M. ; Mathis, K. L. ; Larson, David. / Comparison of recovery and outcome after left and right colectomy. In: Colorectal Disease. 2019.
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AU - Mathis, K. L.

AU - Larson, David

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N2 - Aim: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results: In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion: Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.

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