PHILADELPHIA — The traditional markers used to identify patients who have recovered from major abdominal surgery were ineffective in a study with 124 patients.
“It's unclear whether surrogate markers correlate with important clinical measures of recovery from abdominal surgery, such as a patient's tolerance of oral intake,” Marc Brozovich, M.D., said at the annual meeting of the American Society of Colon and Rectal Surgeons.
The ability of bowel sounds, flatus, and first bowel movement following surgery to flag patients who recovered from major abdominal surgery was tested in a prospective study with 124 patients who underwent procedures such as colorectal surgery, exploratory laparotomy, and small-bowel resection at Western Pennsylvania Hospital in Pittsburgh.
Bowel sounds were monitored once per day by a third-year medical student who performed auscultation for 1 minute in the periumbilical area. Any sound heard during this examination was scored as a positive bowel sound. Patients were questioned daily to determine the time when they recovered flatus and had their first bowel movement.
The median length of hospitalization was 6 days, and the mean duration spent in the hospital was 8 days.
All three markers tested showed no reliable correlation with patients' tolerance of at least 1 L of oral fluid intake in a 24-hour period, Dr. Brozovich said.
On the basis of the new findings, “we recommend that assessment of postoperative ileus should not rely on bowel sounds, flatus, or bowel movement,” said Dr. Brozovich, a colorectal surgeon at Western Pennsylvania Hospital. “Better markers of recovery include tolerance of oral fluid intake, patients' ability to hydrate themselves, whether patients get adequate pain control from oral medications, and their ability to care for themselves as outpatients.”