Incidence and risk factors of post-operative ileus in adult patients at Kenyatta national hospital.

Abstract

Background Ileus is a state of hypomotility of the intestines that impairs propulsion of intestinal contents when there is lack of mechanical obstruction. It leads to intestinal contents (i.e. gas and fluids) building up within the bowel. Postoperative ileus (POI) is an often anticipated state of transient bowel hypomotility after abdominal surgery. Perioperative circumstances may change the intestinal equilibrium leading into disorganized electrical activity and paralysis of intestinal segments. This state is selflimiting with recovery of regular bowel motor function within 3-5 days after surgery. In some incidences this recovery of bowel function may extend beyond the anticipated duration causing considerable frustration for patients and their caregivers. These frustrations arise from adverse clinical sequelae such as nosocomial infections, pulmonary complications and escalation of medical bills. Previously, variations amongst clinicians around the world were a big challenge for validation of prior studies. This has recently been addressed in research developing standardised terms to evaluate this clinical entity. Locally there had been no reports on the incidence of POI nor its risk factors. This study aimed to fill this gap and in doing so stimulate better practice within our setup and thus improve our patient outcomes. Objectives The main objective of the study was to determine the incidence and risk factors of postoperative ileus amongst adult patients undergoing abdominal surgery at the Kenyatta National Hospital (KNH). Study Design This was a cross-sectional study conducted at the Kenyatta National Hospital. Methodology Participants were recruited in the post-operative period after undergoing abdominal surgeries in the surgical units at KNH by convenient sampling. This was carried out from December 2019 to May 2020. A structured data collection sheet was utilised for data collection. Data was derived from both the patient and their medical records in the file. This data was then used to determine patients who develop POI based on defined clinical endpoints and thereafter a determination of the risk factors for POI in those patients who fulfilled the clinical criteria. Data Management The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 26 and analyzed for proportion and associations and the results presented in form of means, median or standard deviation for continuous variables. Categorical data was presented as frequencies and percentages with the use of graphs and pie charts where applicable. Chi-square test was used to test bivariate relationships. Results A total of 243 patients undergoing abdominal surgery were recruited. The mean age of the study population was 38.7 years. 67.8% were female and 32.2% male. The study population underwent various elective and emergency abdominal procedures of general surgical, obstetric and gynaecological indications. The incidence of postoperative ileus in adult patients undergoing abdominal surgery at KNH was 10.7%. There were positive associations of POI occurrence with several risk factors such as history of prior abdominal surgery, abdominal soiling, intestinal surgery and high grade complications. Of the risk factors evaluated, the most significant identified was high grade complications with a Clavien Dindo score ≥ 2 with an odds risk ratio 28.8 (1.6 – 518.1) at 95% CI (p=0.001) Conclusions The incidence of POI within our setup as described in this study is 10.7%. The most significant risk associated with POI was high grade complications as per the Clavien Dindo scale. We need to place an emphasis on our principles of surgery to minimise our postoperative complications and thus reduce the risk of POI in those patients who develop postoperative complications. Possibly future studies inclusive of broader risk factors could enable us derive a predictive index for POI within our setup so we may anticipate and better manage the patient.