Risk Factors For The Development Of Early Postoperative Ileus After Radical Cystectomy And Ileal Conduit

Objective:Identifying the risk factors of early postoperative ileus(POI)after after radical cystectomy(RC)and ileal conduit(IC)to provide a basis for improving prevention and management in the future.Methods:Review the clinical data of 148 patients who underwent RC+IC from August 2013 to June 2019 in Guizhou Provincial People's Hospital.They were divided into POI group and non-POI group according to whether early POI occurred.Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of early POI.Results:Among the 148 patients,there were 119 males and 29 females,with an average age of63.8±8.7 years old and an average body mass index(BMI)of 23.5±3.7kg/m~2.29patients underwent open surgery and 119 patients underwent laparoscopic surgery.22patients(14.9%)were diagnosed with POI in the early postoperative period,including14 cases of inflammatory bowel obstruction and 8 cases of paralytic intestinal obstruction.Through the analysis of the clinical data of the two groups,it was found that compared with the patients without POI,the patients with POI were significantly older(65.5±7.6 y vs 62.3±8.5 y,P=0.023),larger BMI(24.5±4.2 kg/m~2vs 22.6±3.5kg/m~2,P=0.032),greater intraoperative blood loss[500(350,850)ml vs 250(100,500)ml,P=0.003],higher incidence of postoperative albumin<30g/l[45.4%(10/12)vs23.8%(30/126),P=0.035],and the hospitalization time of patients with POI was significantly longer[25(17,36)d vs 18(13,25)d,P=0.001].However,there were no statistically significant differences between the two groups in Gender,history of tobacco and alcohol,diabetes,hypertension,Preoperative final level of(hemoglobin,creatinine,albumin),American Society of Anesthesiologists(ASA)score,operation method,operation time,tumor stage,postoperative electrolyte disorders and so on(all P>0.05).The above factors that may affect the development of POI were included in Logistic multivariate regression analysis and results showed that age(OR=1.067,95%CI=1.009?1.128,P=0.023),BMI(OR=1.165,95%CI=1.035?1.311,P=0.011),intra-operative blood loss(OR=1.001,95%CI=1.000?1.002,P=0.017)are independent risk factors for early POI,and postoperative serum albumin<30g/l is not an independent risk factor for early POI(OR=2.001,95%CI=0.697?5.797,P=0.196).Conclusion:Early POI is a common complication after RC+IC and most of which are effectively treated conservatively.Age,BMI,and intraoperative blood loss are the main risk factors for Early POI.