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. 2018 Oct 1;3(1):1-10.
doi: 10.1002/bjs5.102. eCollection 2019 Feb.

Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery

S J Chapman  1 , G Thorpe  2 , A E Vallance  3 , D P Harji  4 , M J Lee  5 , N S Fearnhead  6 ; Association of Coloproctology of Great Britain and Ireland Gastrointestinal Recovery Group
Affiliations

Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery

S J Chapman et al. BJS Open. .

Abstract

Background: Ileus is common after gastrointestinal surgery and has been identified as a research priority. Several issues have limited previous research, including a widely accepted definition and agreed outcome measure. This review is the first stage in the development of a core outcome set for the return of bowel function after gastrointestinal surgery. It aims to characterize the extent of variation in current outcome reporting.

Methods: A systematic search of MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library was performed for 1990-2017. RCTs of adults undergoing gastrointestinal surgery, including at least one reported measure relating to return of bowel function, were eligible. Trial registries were searched across the same period for ongoing and completed (but not published) RCTs. Definitions of ileus and outcome measures describing the return of bowel function were extracted.

Results: Of 5670 manuscripts screened, 215 (reporting 217 RCTs) were eligible. Most RCTs involved patients undergoing colorectal surgery (161 of 217, 74·2 per cent). A total of 784 outcomes were identified across all published RCTs, comprising 73 measures (clinical: 63, 86 per cent; radiological: 6, 8 per cent; physiological: 4, 5 per cent). The most commonly reported outcome measure was 'time to first passage of flatus' (140 of 217, 64·5 per cent). The outcomes 'ileus' and 'prolonged ileus' were defined infrequently and variably.

Conclusion: Outcome reporting for the return of bowel function after gastrointestinal surgery is variable and not fit for purpose. An agreed core outcome set will improve the consistency, reliability and clinical value of future studies.

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Figures

Figure 1
Figure 1
Flow diagram of included studies. GI, gastrointestinal
Figure 2
Figure 2
Map of 73 identified outcome measures according to core areas. GI‐2, composite outcome measure – time taken to pass first stool and tolerate oral intake; GI‐3, composite outcome measure – time taken to pass first stool or flatus and tolerate oral intake
See this image and copyright information in PMC

References

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