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

1 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Gastroenterology

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    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