Incidence of and risk factors for postoperative ileus in women undergoing primary staging and debulking for epithelial ovarian carcinoma

Jamie N Bakkum-Gamez, Carrie L. Langstraat, Janice R. Martin, Maureen A. Lemens, Amy L. Weaver, Sumer Allensworth, Sean Christopher Dowdy, William Arthur Cliby, Bobbie S. Gostout, Karl C. Podratz

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC. Methods: We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables with P ≤.20 were included in multivariate analysis. Results: Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection; P =.002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P <.001 for each). Conclusions: The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.

Original languageEnglish (US)
Pages (from-to)614-620
Number of pages7
JournalGynecologic Oncology
Volume125
Issue number3
DOIs
StatePublished - Jun 2012

Fingerprint

Ileus
Carcinoma
Incidence
Ibuprofen
Length of Stay
Thrombocytosis
Erythrocyte Transfusion
Mesentery
Mouth
Gastrointestinal Tract
Multivariate Analysis

Keywords

  • Bowel recovery
  • Ovarian cancer
  • Postoperative ileus

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Incidence of and risk factors for postoperative ileus in women undergoing primary staging and debulking for epithelial ovarian carcinoma. / Bakkum-Gamez, Jamie N; Langstraat, Carrie L.; Martin, Janice R.; Lemens, Maureen A.; Weaver, Amy L.; Allensworth, Sumer; Dowdy, Sean Christopher; Cliby, William Arthur; Gostout, Bobbie S.; Podratz, Karl C.

In: Gynecologic Oncology, Vol. 125, No. 3, 06.2012, p. 614-620.

Research output: Contribution to journalArticle

Bakkum-Gamez, Jamie N ; Langstraat, Carrie L. ; Martin, Janice R. ; Lemens, Maureen A. ; Weaver, Amy L. ; Allensworth, Sumer ; Dowdy, Sean Christopher ; Cliby, William Arthur ; Gostout, Bobbie S. ; Podratz, Karl C. / Incidence of and risk factors for postoperative ileus in women undergoing primary staging and debulking for epithelial ovarian carcinoma. In: Gynecologic Oncology. 2012 ; Vol. 125, No. 3. pp. 614-620.
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abstract = "Objective: Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC. Methods: We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables with P ≤.20 were included in multivariate analysis. Results: Among 587 women identified, the overall incidence of POI was 30.3{\%} (25.9{\%} without bowel resection, 38.5{\%} with bowel resection; P =.002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P <.001 for each). Conclusions: The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.",
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T1 - Incidence of and risk factors for postoperative ileus in women undergoing primary staging and debulking for epithelial ovarian carcinoma

AU - Bakkum-Gamez, Jamie N

AU - Langstraat, Carrie L.

AU - Martin, Janice R.

AU - Lemens, Maureen A.

AU - Weaver, Amy L.

AU - Allensworth, Sumer

AU - Dowdy, Sean Christopher

AU - Cliby, William Arthur

AU - Gostout, Bobbie S.

AU - Podratz, Karl C.

PY - 2012/6

Y1 - 2012/6

N2 - Objective: Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC. Methods: We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables with P ≤.20 were included in multivariate analysis. Results: Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection; P =.002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P <.001 for each). Conclusions: The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.

AB - Objective: Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC. Methods: We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables with P ≤.20 were included in multivariate analysis. Results: Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection; P =.002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P <.001 for each). Conclusions: The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.

KW - Bowel recovery

KW - Ovarian cancer

KW - Postoperative ileus

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