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Selective Opioid Antagonists Following Bowel Resection for Prevention of Postoperative Ileus: a Systematic Review and Meta-analysis.
McKechnie, Tyler; Anpalagan, Tharani; Ichhpuniani, Simarpreet; Lee, Yung; Ramji, Karim; Eskicioglu, Cagla.
Afiliación
  • McKechnie T; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
  • Anpalagan T; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Ichhpuniani S; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Lee Y; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
  • Ramji K; Division of General Surgery, Department of Surgery, St. Joseph Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, Ontario, L8N 4A6, Canada.
  • Eskicioglu C; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. eskicio@mcmaster.ca.
J Gastrointest Surg ; 25(6): 1601-1624, 2021 06.
Article en En | MEDLINE | ID: mdl-33768428
BACKGROUND: Postoperative ileus (POI) remains a common complication following bowel resection. Selective opioid antagonists have been increasingly studied as prophylactic pharmaceutical aids to reduce rates of POI. The aim of this study was to evaluate the impact of selective opioid antagonists on return of bowel function following bowel resection. METHODS: MEDLINE, Embase, and CENTRAL were systematically searched. Articles were included if they compared the incidence of POI and/or length of stay (LOS) in patients receiving and not receiving selective opioid antagonists following elective bowel resection. A pairwise meta-analyses using inverse variance random effects was performed. RESULTS: From 636 citations, 30 studies with 45,051 patients receiving selective opioid antagonists (51.3% female, mean age: 60.9) and 55,071 patients not receiving selective opioid antagonists (51.2% female, mean age: 61.1) were included. Patients receiving selective opioid antagonists had a significantly lower rate of POI (10.1% vs. 13.8%, RR 0.68, 95%CI 0.63-0.75, p < 0.01). Selective opioid antagonists also significantly reduced LOS (MD - 1.08, 95%CI - 1.47 to - 0.69, p < 0.01), readmission (RR 0.94, 95%CI 0.89-0.99, p = 0.03), and 30-day morbidity (RR 0.85, 95%CI 0.79-0.90, p < 0.01). Improvements in LOS, readmission rate, and morbidity were not significant when analysis was limited to laparoscopic surgery. There was no significant difference in inpatient healthcare costs (SMD - 0.33, 95%CI - 0.71-0.04, p = 0.08). CONCLUSIONS: Rate of POI decreases with the use of selective opioid antagonists in patients undergoing bowel resection. Selective opioid antagonists also improve LOS, rates of readmission, and 30-day morbidity for patients undergoing open bowel resection. Addition of these medications to enhance recovery after surgery protocols should be considered.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos del Sistema Digestivo / Ileus Tipo de estudio: Etiology_studies / Systematic_reviews Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Gastrointest Surg Asunto de la revista: GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos del Sistema Digestivo / Ileus Tipo de estudio: Etiology_studies / Systematic_reviews Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Gastrointest Surg Asunto de la revista: GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos