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

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

Anesth Analg. 2018 Jun;126(6):1896-1907.

What is already known:

A delayed return to normal GI function or the development of ileus will likely prolong hospital length of stay and several elements of ERAS are aimed towards the avoidance of GI complications. A number of definitions of ileus exist with considerable variation in their diagnostic criteria.

What this paper adds:

This paper is written by the Perioperative Quality Initiative (POQI) 2 workgroup, an international collaborative of experts in anaesthesia, surgery, nutrition and nursing. In order to better define ileus and aid in ascertaining its true incidence the group propose a rational definition of ileus or Post-Operative Gastrointestinal Dysfunction (POGD). The group propose a scoring system (I-FEED) comprising five elements helping to diagnose POGD. They go on to recommend a number of strategies aimed at reducing the incidence of POGD, several of which are found in ERAS protocols such as multimodal analgesia (with opioid avoidance) and avoidance of NG tubes. Other elements such as the use of chewing gum, coffee and alvimopan are reviewed and evidence-graded. The paper also includes evidence-based treatment strategies for patients developing POGD.

Dr Ben Morrison