Risk factors for postoperative ileus in hysterectomy: A Systematic Review and Meta-analysis

Abstract Background: Postoperative ileus (POI) is a common complication after hysterectomy, with an incidence of 2%. However, according to statistics, there are more than 400,000 hysterectomy patients every year. Therefore, there may be thousands of people who may develop POI after hysterectomy. Estimates of medical costs spent on POI range from $750 million to $1 billion annually. Thus, the occurrence of POI undoubtedly increases the family and medical burden. Moreover, the pathogenesis of POI is not clear, and there is a lack of effective preventive measures at present. Therefore, understanding related risk factors is of guiding value for understanding POI and accelerating surgical rehabilitation of patients after hysterectomy. So, the aim of this study was to evaluate the risk factors of POI in hysterectomy patients. Methods: This study conducted a systematic review and meta-analysis in accordance with the PRISMA Statement. PubMed, EMBASE, Web of Science, Medline and the Cochrane Library databases were searched. The search period is from inception until December 2018. Key words used were: hysterectomy, postoperative ileus, postoperative intestinal obstruction, risk factors, factors. Two researchers screened literatures and extracted data, and used Newcastle-Ottawa scale to evaluate their quality. Then, Stata17 software was used for statistical analysis. Result: A total of 5 literatures were included, and the results of meta-analysis showed that undergone adhesiolysis (OR=1.86, 95%CI: 1.37-2.53), duration of surgery (OR=1.78, 95%CI: 1.32-2.40), perioperative transfusion (OR=4.50, 95%CI: 3.29-6.16) and Concomitant bowel surgery (OR=3.11, 95%CI: 1.47-6.57) were the risk factors for POI development in hysterectomy patients. The included studies showed low heterogeneity. Conclusions: The results of this study were mainly surgical factors, including several aspects, which may all increase the risk of POI in hysterectomy patients. After the conclusion of risk factors, more accurate screening and identification of high-risk groups can be conducted and timely preventive measures can be taken to reduce the incidence of POI. Trial registration: The study protocol for this meta-analysis was registered (CRD42023407167) with the PROSPERO database (www. crd.york.ac.uk/prospero)