Mosapride Reduces Prolonged Postoperative Ileus after Open Colorectal Surgery in the Setting of Enhanced Recovery after Surgery (ERAS): A Matched Case-Control Study

Objective: To evaluate the effects of mosapride, a selective 5-hydroxytryptamine-4 agonist, on gastrointestinal recovery in patients undergoing open colorectal surgery. Methods: A prospectively collected database of the patients undergoing elective 'open' colorectal resection under enhanced recovery after surgery (ERAS) from May 2013 to April 2017 was reviewed. From April 2016, mosparide was routinely given from postoperative day 1 to discharge date. Eighty-four patients receiving mosapride were matched to 168 control patients (historical comparison with a ratio of 1:2). Surgical outcomes and postoperative gastrointestinal recovery was compared. Results: The patient characteristics were comparable except more patients in control group had perioperative administration of NSAIDs. The mosapride group had a 1.5% higher compliance rate of ERAS protocol. The control group had higher incidences of prolonged postoperative ileus (17.3% vs 7.1%; p=0.029) and prolonged postoperative ileus requiring nasogastric tube decompression (8.9% vs 3.6%; p=0.19). Overall complication, clinical intestinal transit and length of hospitalization were not significantly different between groups. However, the patients with prolonged postoperative ileus had significantly prolonged hospitalization (p<0.001). Median length of hospital stay was 4 days (IQR 4-5) in those without prolonged ileus (n=217), 5 days (IQR 5-6) in those with prolonged ileus without a need of gastric decompression (n=17) and 10.5 days (IQR 7-14.5) in those with prolonged ileus requiring nasogastric tube decompression (n=18) (p<0.001). A multivariate analysis showed that administration of mosapride was only a protective factor for prolonged postoperative ileus (OR=0.37, 95% CI=0.15-0.93, p=0.029). Conclusion: Postoperative administration of mosapride reduced the incidence of prolonged postoperative ileus after open colorectal surgery.