113 Systematic review of definitions and outcome measures for postoperative ileus and return of bowel function after abdominal surgery in children Chapter 4 Outcome No. of reports Outcome category Toleration of food 24 hours after operation 1 Gastric motility Time to solid foods 1 Gastric motility Presence of postoperative loose stools 1 Intestinal motility Requirement of nasogastric suction 1 Gastric motility Time to minimal enteral feeding (20ml/kg/day) 1 Gastric motility Daily and cumulative feed volumes /kg 1 Gastric motility Number of days in which stools were passed 1 Intestinal motility Amount of full feeding hours (toleration of more than 80% of the calculated daily maintenance volume) 1 Gastric motility Time to tolerate 80% of regular diet 1 Gastric motility Time to normal bowel sounds 1 Intestinal motility Time to reach 50% enteral nutrition 1 Gastric motility Duration of enteral nutrition 1 Gastric motility Age at total enteral feeding 1 Gastric motility Time to removal of nasogastric tube 1 Gastric motility Starvation period 1 Gastric motility Discussion This review reports on the multiple definitions and outcome measures used for postoperative ileus and return of bowel function in children. It shows a profound lack of the use of definitions and, moreover, inconsistency within the definitions when used. Whilst “abdominal distension” stands out within the outcome measures used to describe postoperative ileus, two-third of the reported outcome measures was used only once. For return of bowel function multiple outcome measures make up an equally large proportion of the reported outcome measures, describing either return of gastric or intestinal motility. This variation hampers the interpretation of the results and decreases the comparability amongst studies. Having a clear definition and a uniform set of outcome measures for postoperative ileus is vital in the evaluation of interventions for prevention or treatment. There are multiple reviews, retrospective and prospective articles with the subject postoperative ileus in children reporting on incidences, interventions and preventative measures showing the possibilities to improve the postoperative process in children(1, 2, 21, 83). However, without consistency in both a definition and outcome measures for postoperative ileus it will be nearly impossible to evaluate or replicate these studies. Moreover, it will hamper the conduct of future meta-analysis. These issues show the need for an agreed definition and core-outcome set.
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