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Anesth Analg. 2018 Jun;126(6):1896-1907. doi: 10.1213/ANE.0000000000002742.

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery.

Author information

1
From the Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
2
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
3
Department of Anaesthesia, University College London, London, United Kingdom.
4
Division of Colon and Rectal Surgery, Westchester Medical Center, Valhalla, New York.
5
Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, New York.
6
Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.
7
Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
8
Division of Advanced Oncologic and Gastrointestinal Surgery.
9
Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, North Carolina.

Abstract

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.

PMID:
29293183
DOI:
10.1213/ANE.0000000000002742
[Indexed for MEDLINE]

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