105 Systematic review of definitions and outcome measures for postoperative ileus and return of bowel function after abdominal surgery in children Chapter 4 Introduction The return of bowel function following abdominal surgery or, in the absence of it, the occurrence of postoperative ileus is a commonly studies subject in children (≤18 years). It a clinically frequent problem in children with, for instance, an incidence of 14% in gastroschisis patients (1). This frequent complication hampers recovery after surgery. Ileus and gastro-intestinal obstructions are responsible for almost one in five (19%) of the unplanned readmissions in the first thirty days following surgery in children in the United States (2). In order to be able to develop strategies preventing postoperative ileus, it is important to define what separates postoperative ileus from normal return of bowel function and standardize the outcome measures which should be used to describe it. In recent years, there have been attempts to define postoperative ileus in adults using different study methods. This has resulted in the use of multiple, and sometimes contradictory, definitions and outcome measures. In 2013, a global survey resulted in a differentiation between “normal” postoperative ileus and prolonged ileus (3). The authors of this study defined prolonged postoperative ileus as “two or more of the following occurring on or after day 4 postoperatively: nausea/vomiting, inability to tolerate oral diet over 24h, absence of flatus over 24h, distension, radiologic confirmation”. Then, in 2017 a Delphi study did not agree with this distinction between normal and prolonged, suggesting only to use postoperative ileus (4). They proposed to define postoperative ileus as “a temporary inhibition of gastrointestinal motility after surgical intervention due to non-mechanical causes and prevents sufficient oral intake.” Moreover they suggested that the most important diagnostic criteria were abdominal distension, tenderness, and the absence of normal bowel sounds. Auscultation however, has been reported to have low predictive value and high intra-observer variability(5). This lack of standardisation has led to high variation in the definitions and outcome measures used by researchers to describe postoperative ileus. A review, published in 2019, in randomized controlled trials performed in adults undergoing abdominal surgery showed the use of 784 different outcomes return of bowel function (6). Of these different outcomes, one in three (34%) was solely used once and less than 29% of the studies defined postoperative ileus. These differences make it hard to compare results amongst studies which will complicate translating research results into the clinical practice. As a result, the authors of this review aim to finish the development of a core-outcome set for adults (≥18 years) by the end of 2021 (7). It is unsure however, if this outcome set is fit for use in children since it seems that there might be clinical differences between postoperative ileus in children and adults. In adults it seems that the primary focus is on return of intestinal motility; passage of flatus or stool
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