eP472 - Do You Have to Go Slow to Go Fast? Clinical Outcomes of Colonic Inertia Patients with and Without Promotility Agents

Purpose/Background: Background: Surgical intervention for Colonic Inertia can be successful in properly selected patients. However, poor outcomes are common, especially in those with concomitant pelvic floor dysfunction, delayed gastric emptying, and mental health issues. Prior to surgery, patients will have trialed different types of medical management; dietary changes, fiber supplementation, laxatives, and promotility agents. It is unknown if the use of promotility agents prior to surgery alters the immediate post-operative outcomes.

Aim: Evaluate differences in immediate post-operative outcomes among patients undergoing surgery for colonic inertia who are not taking promotility agents versus those who are taking promotility agents.Methods/Interventions:

Method: Retrospective chart review of the electronic medical record from a single tertiary-care center from 2010-2023. Cases were included if the patient underwent a colorectal surgery with the ICD 10 code for Colonic Inertia, and similar diagnoses. Two abstractors reviewed operative reports, progress notes, medication lists, and discharge summaries. Patients were excluded if they did not have complete records or underwent surgery for a different primary diagnosis. Patients were stratified into two groups: no promotility agents group prior to surgery (NPG) and promotility agent group prior to surgery (PAG). Patient gender, age, procedure, Enhanced Recovery after Surgery status (ERAS), surgeon, length of stay, time to first flatus, time to first bowel movement, need for a nasogastric tube, days post diet advancement that a patient was made nil-per-os (NPO), and if a promotility agent was prescribed pre-operatively.Results/Outcomes:

Results: 54 patients were identified that underwent a colorectal surgery for colonic inertia. 31 patients had complete records, 19 patients did not take a promotility agent pre-operatively (61% NPG) and 12 did take a promotility agent (39% PAG). 6 of the PAG patients took more than one agent 50%. All patients in the study were female. 61% were in an ERAS protocol post-operatively. There was statistically significant difference in average length of stay in for the NPG (5.8 days) and in PAG (7.4 days). There was no significant difference in return of bowel function, including first flatus and first bowel movement, (NPG 2 days and PAG 2.4 days). In patients who were made NPO after having their diet advanced, patients NPG patients were made NPO sooner than PAG patients (1.2 days vs 2.6 days). PAG patients were significantly more likely to require a nasogastric tube placed than NPG patients, (Odds Ratio 1.9).Conclusion/

Discussion: Limitations: This is a retrospective, single center case series of 32 patients undergoing surgery for Colonic Inertia. Due to the small sample size, this retrospective study may be under powered. The results may not be generalizable given the small number of patients in both NPG and PAG.

Conclusion: In patients who undergo surgery for Colonic Inertia, there is no difference in length of stay or return of bowel function in patients who do not use promotility agents and those who do use promotility agents. However, in patients who pre-operatively use promotility agents they are more likely to have a delayed ileus and require a nasogastric tube."Table I - Demographics

Table II - Type of Surgery

Table III - No Promotility Agent (NPG) vs Promotoility Agent (APG)

Table IV - Promotility Agents
"