Postoperative ileus following radical cystectomy in current urological practice: Incidence and risk factors

Introduction: Postoperative Ileus (POI) is a common complication after Radical Cystectomy (RC), often leading to delayed recovery and extended hospital stay. Given the developments in perioperative techniques and the implementation of enhanced recovery protocols, it is essential to evaluate the risk factors contributing to POI. Our objective was to analyze various risk factors that impact the incidence of POI after RC in contemporary practice. Methods: A retrospective study of bladder cancer patients who underwent RC with ileal conduit or neobladder was conducted. Baseline characteristics and perioperative variables were compared between patients with and without POI. Logistic regression was used to identify the risk factors for the development of POI. Results:  Of the 269 patients who underwent RC in the study period, 25 (9.29%) patients developed POI. The POI cohort demonstrated significantly increased age ( p  < 0.029), a higher American Society of Anesthesiologists (ASA) class status ( p  < 0.001), and a history of chronic obstructive pulmonary disease (COPD) ( p  < 0.019). Although the result remained marginal, the day of passage of flatus after RC ( p  = 0.052) showed a tendential association with POI. The logistic regression analysis revealed that age ( p  = 0.01), ASA class status ( p  = 0.010), Charlson Comorbidity Index ( p  = 0.0216), history of COPD ( p  = 0.02), and preoperative hemoglobin ( p  = 0.0382) were identified to be independent risk factors for POI. Conclusion: POI remains a notable complication after RC. Age, comorbidity burden, ASA class, history of COPD, and preoperative hemoglobin were identified as independent risk factors. These findings reinforce the multifactorial nature of POI and emphasize the need for early recognition of these factors for reducing POI following RC. Furthermore, this could also enable targeted preoperative optimization, such as anemia correction, pulmonary prehabilitation, and comprehensive perioperative planning for older patients and those with high ASA scores.