Validity of the I-FEED score for postoperative gastrointestinal function in patients undergoing colorectal surgery
Validity of the I-FEED score for postoperative gastrointestinal function in patients undergoing colorectal surgery
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DOI：
10.1007/s00464-019-07011-6
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发表时间：
2020-05-01
影响因子：
3.1
通讯作者：
Lee, Lawrence
中科院分区：
文献类型：
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作者：
Alsharqawi, Nourah;Alhashemi, Mohsen;Lee, Lawrence
背景术后肠梗阻（POI）是胃肠道手术后常见的并发症，并与显著的发病率和费用相关。然而，POI定义不明确。I-FEED评分是由专家共识开发的POI的新结局指标。它包含五个要素（摄入量、对恶心治疗的反应、呕吐、检查和持续时间，每个评分为0、1或3分），并将患者分为正常、术后胃肠道不耐受（POGI）和术后胃肠道功能障碍（POGD）。然而，它尚未在临床环境中得到验证。本研究旨在为I-FEED评分测量结直肠手术患者POI结构提供有效性证据。方法分析之前从一项临床试验中收集的数据，该试验研究了不同围手术期液体管理策略对择期腹腔镜结肠切除术患者原发性POI的影响（2013-2015年）。患者由长期的增强恢复计划管理（预期住院时间（LOS）：3天）。生成每日I-FEED评分（正常0-2分，POGI 3-5分，POGD 6+分），直至出院或术后第7天。通过检验以下假设来评估有效性：（1）GI 3（耐受饮食+排气/排便）时间较长的患者，（2）LOS较长（> 3天vs较短）的患者，（3）有并发症vs无并发症的患者，（4）恢复较差的患者（通过恢复质量-9问卷测量）的I-FEED评分较高。结果共纳入128例患者进行分析（平均年龄61.7岁（SD 15.2），57%为男性，71%为恶性肿瘤，39.1%为直肠切除）。中位LOS为4天[IQR 3 -5]，32%的患者发生术后住院并发症。总体而言，48%的患者被归类为正常，22%为POGI，30%为POGD。数据支持所有4个假设。结论本研究为I-FEED评分作为结直肠手术后POI的测量提供了初步的有效性证据。
Background Postoperative ileus (POI) is common after gastrointestinal surgery and is associated with significant morbidity and costs. However, POI is poorly defined. The I-FEED score is a novel outcome measure for POI, developed by expert consensus. It contains five elements (intake, response to nausea treatment, emesis, exam, and duration, each scored with 0, 1, or 3 points) and classifies patients into normal, postoperative gastrointestinal intolerance (POGI), and postoperative gastrointestinal dysfunction (POGD). However, it has not yet been validated in a clinical context. The objective was to provide validity evidence for the I-FEED score to measure the construct of POI in patients undergoing colorectal surgery. Methods Data previously collected from a clinical trial investigating the impact of different perioperative fluid management strategies on primary POI in patients undergoing elective laparoscopic colectomy (2013-2015) were analyzed. Patients were managed by a longstanding Enhanced Recovery program (expected length of stay (LOS): 3 days). Daily I-FEED scores were generated (normal 0-2, POGI 3-5, POGD 6+ points) up to hospital discharge or postoperative day 7. Validity was assessed by testing the hypotheses that I-FEED score was higher (1) in patients with longer time to GI3 (tolerating diet + flatus/bowel movement), (2) with longer LOS (> 3 days vs shorter), (3) in patients with complications vs without, (4) in patients with poorer recovery (measured by Quality of Recovery-9 questionnaire). Results A total of 128 patients were included for analysis (mean age 61.7 years (SD 15.2), 57% male, 71% malignancy, and 39.1% rectal resection). Median LOS was 4 days [IQR3-5], and 32% experienced postoperative in-hospital morbidity. Overall, 48% of patients were categorized as normal, 22% POGI, and 30% POGD. The data supported all 4 hypotheses. Conclusions This study contributes preliminary validity evidence for the I-FEED score as a measure for POI after colorectal surgery.