Laurens Schattenkerk

114 Chapter 4 Recently, a published review displayed the same inconsistency in definitions and outcome measures in adult literature on postoperative ileus, which has prompted the authors to develop a core-outcome set specifically for adults (6). In adults, most studies used the outcome measures ‘time to first passage of flatus’, time to first passage of stool’ and ‘time to first bowel movement’. All of these outcome measures would be categorized as return of intestinal motility following the definitions of our review. The importance of return of intestinal motility is significantly associated with clinical recovery in adults which is not the case for gastric motility (84). Contrarily to adults, our results show that return of intestinal motility is used less in children in which return of gastric motility seems more important. This could partly be related to the relatively high percentage of upper gastrointestinal surgery in this review (68%) compared to the review in adult surgery (26%)(6). Due to this difference it seems plausible that, if the core-outcome set for adults will focus primarily on the return of intestinal motility it would be less applicable for children. Therefore, we believe that a definition and core-outcome set should be developed for children specifically. Previous studies which tried to develop a definition for postoperative ileus in adults mostly received input from (colorectal) surgeons (3, 4). Since the care during admission of surgically treated children is even more profoundly multidisciplinary we want to stress the importance of including the opinion of paediatricians, neonatologists and gastroenterologists on definitions and outcome measures in children. This review has certain limitations. Due to the small amount of articles per age group we were unable to evaluate differences between age groups. These differences could well exist, most probably between new-borns and adolescents, which should be addressed during a Delphi study. Moreover, the separation we made between postoperative ileus and return of bowel function might influence the interpretation of the presented results. We feel however, that articles which use postoperative ileus as an outcome seem to reason from a complication that does or doesn’t occur. This implies that beforehand, either of inclusion or analysis, they had some sort of definition to which they assessed their findings. Articles using return of bowel function on the other hand, seem to have chosen a method focussing more on observation within their cohort rather than evaluation to a previous set definition. This could also partly explain why no articles on return of bowel function provided a definition. Although these differences might exists, both give important information on outcome measures presumed to be of importance. For this reason we separated our findings into postoperative ileus and return of bowel function. Lastly, 44% of the included articles are written before the year 2009, although it seems that with increasing years the number of articles focussing on this subject seems to rise. There was no trend in recent articles being more consistent in the usage of a definition or similar outcome measures.

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