{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:06:22Z","timestamp":1784091982702,"version":"3.55.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007109","name":"Universit\u00e0 degli Studi di Ferrara","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007109","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Colorectal Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Prolonged postoperative ileus (PPOI) is a frequent complication after colorectal surgery. Several prediction models have been proposed to estimate PPOI risk, but few have undergone external validation, limiting their generalizability and clinical usefulness. The primary aim of this study was to externally validate two predictive models for PPOI after colorectal resection; a secondary aim was to explore factors associated with PPOI in our cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from all consecutive patients who underwent elective colorectal resection in our department between 2019 and 2022 were retrospectively analyzed from a prospective database. Eligible criteria were age\u2009\u2265\u200918 years, elective colorectal resection, and ASA score I\u2013III. Based on a recent systematic review, we selected the models by Hain et al. and Wolthuis et al. for external validation, as all required variables were available in our dataset. Model performance was assessed in terms of discrimination, calibration, and overall accuracy. An exploratory multivariable regression analysis was also performed to assess factors associated with PPOI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 200 patients undergoing colorectal resection, 43 (21.5%) developed PPOI. Both prediction models showed poor external performance. The Hain model had a\n                      <jats:italic>C<\/jats:italic>\n                      -statistic of 0.597 (95% CI 0.514\u20130.681) and the Wolthuis model a\n                      <jats:italic>C<\/jats:italic>\n                      -statistic of 0.589 (95% CI 0.501\u20130.677), with suboptimal calibration and limited overall accuracy. In secondary exploratory multivariable analyses, postoperative opioid use was associated with PPOI in both models. In the model excluding postoperative oral intake initiation and autonomous postoperative mobilization, splenic flexure mobilization was associated with lower odds of PPOI; in the fully adjusted model, delayed postoperative oral intake initiation was associated with PPOI. These exploratory local findings should be interpreted as hypothesis-generating.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>External validation of two previously published PPOI prediction models demonstrated poor performance in this cohort, limiting their transportability to our setting. The secondary exploratory analysis identified potentially relevant postoperative factors, but these findings should be considered hypothesis-generating. Further research should prioritize harmonized PPOI definitions and robust multicentre validation of prediction models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00384-026-05152-4","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:44:37Z","timestamp":1779446677000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External validation of predictive models for prolonged postoperative ileus following colorectal resection"],"prefix":"10.1007","volume":"41","author":[{"given":"Camilo","family":"Ram\u00edrez-Giraldo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Cirillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Lucietto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Fabbri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Biondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Feo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pesce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"issue":"1-2","key":"5152_CR1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1111\/ans.17297","volume":"92","author":"CI Wells","year":"2022","unstructured":"Wells CI, Milne TGE, Seo SHB, Chapman SJ, Vather R, Bissett IP et al (2022) Post-operative ileus: definitions, mechanisms and controversies. ANZ J Surg 92(1\u20132):62\u201368. https:\/\/doi.org\/10.1111\/ans.17297","journal-title":"ANZ J Surg"},{"issue":"8","key":"5152_CR2","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1007\/s00268-005-0613-9","volume":"30","author":"P Mattei","year":"2006","unstructured":"Mattei P, Rombeau JL (2006) Review of the pathophysiology and management of postoperative ileus. World J Surg 30(8):1382\u20131391. https:\/\/doi.org\/10.1007\/s00268-005-0613-9","journal-title":"World J Surg"},{"issue":"5","key":"5152_CR3","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1007\/s00268-019-05366-4","volume":"44","author":"AC Quiroga-Centeno","year":"2020","unstructured":"Quiroga-Centeno AC, Jerez-Torra KA, Martin-Mojica PA, Casta\u00f1eda-Alfonso SA, Castillo-S\u00e1nchez ME, Calvo-Corredor OF et al (2020) Risk factors for prolonged postoperative ileus in colorectal surgery: a systematic review and meta-analysis. World J Surg 44(5):1612\u20131626. https:\/\/doi.org\/10.1007\/s00268-019-05366-4","journal-title":"World J Surg"},{"key":"5152_CR4","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1308\/rcsann.2019.0158","volume":"102","author":"MJ Lee","year":"2020","unstructured":"Lee MJ, Vaughan-Shaw P, Vimalachandran D (2020) A systematic review and meta-analysis of baseline risk factors for the development of postoperative ileus in patients undergoing gastrointestinal surgery. Ann R Coll Surg Engl 102:194\u2013203","journal-title":"Ann R Coll Surg Engl"},{"issue":"6","key":"5152_CR5","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1111\/codi.17010","volume":"26","author":"GXH Liu","year":"2024","unstructured":"Liu GXH, Milne T, Xu W, Varghese C, Keane C, O\u2019Grady G et al (2024) Risk prediction algorithms for prolonged postoperative ileus: a systematic review. Colorectal Dis 26(6):1101\u20131113. https:\/\/doi.org\/10.1111\/codi.17010","journal-title":"Colorectal Dis"},{"issue":"5","key":"5152_CR6","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1007\/s11605-013-2148-y","volume":"17","author":"R Vather","year":"2013","unstructured":"Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17(5):962\u2013972. https:\/\/doi.org\/10.1007\/s11605-013-2148-y","journal-title":"J Gastrointest Surg"},{"issue":"1","key":"5152_CR7","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-024-04693-w","volume":"39","author":"W Xiu","year":"2024","unstructured":"Xiu W, Zhang Y, Man Y, Yu Z, Ren D (2024) Personalized risk prediction for prolonged ileus after minimally invasive colorectal cancer surgery: in-depth risk factor analysis and model development. Int J Colorectal Dis 39(1):115. https:\/\/doi.org\/10.1007\/s00384-024-04693-w","journal-title":"Int J Colorectal Dis"},{"key":"5152_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7594","volume":"350","author":"GS Collins","year":"2015","unstructured":"Collins GS, Reitsma JB, Altman DG, Moons KG (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ 350:g7594. https:\/\/doi.org\/10.1136\/bmj.g7594","journal-title":"BMJ"},{"key":"5152_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-074821","volume":"384","author":"RD Riley","year":"2024","unstructured":"Riley RD, Snell KIE, Archer L, Ensor J, Debray TPA, van Calster B et al (2024) Evaluation of clinical prediction models (part 3): calculating the sample size required for an external validation study. BMJ 384:e074821. https:\/\/doi.org\/10.1136\/bmj-2023-074821","journal-title":"BMJ"},{"key":"5152_CR10","doi-asserted-by":"publisher","unstructured":"Collins GS, Dhiman P, Ma J, Schlussel MM, Archer L, Van CalsterB, et al (2024) Evaluation of clinical prediction models (part 1): from development to external validation. BMJ. Jan 8;384:e074819.https:\/\/doi.org\/10.1136\/bmj-2023-074819","DOI":"10.1136\/bmj-2023-074819"},{"issue":"1","key":"5152_CR11","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s00464-017-5681-z","volume":"32","author":"E Hain","year":"2018","unstructured":"Hain E, Maggiori L, Mongin C, Prost A la Denise J, Panis Y (2018) Risk factors for prolonged postoperative ileus after laparoscopic sphincter-saving total mesorectal excision for rectal cancer: an analysis of 428 consecutive patients. Surg Endosc 32(1):337\u2013344. https:\/\/doi.org\/10.1007\/s00464-017-5681-z","journal-title":"Surg Endosc"},{"issue":"6","key":"5152_CR12","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1007\/s00384-017-2824-6","volume":"32","author":"AM Wolthuis","year":"2017","unstructured":"Wolthuis AM, Bislenghi G, Lambrecht M, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G et al (2017) Preoperative risk factors for prolonged postoperative ileus after colorectal resection. Int J Colorectal Dis 32(6):883\u2013890. https:\/\/doi.org\/10.1007\/s00384-017-2824-6","journal-title":"Int J Colorectal Dis"},{"issue":"2","key":"5152_CR13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205\u2013213. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"issue":"5","key":"5152_CR14","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1097\/DCR.0000000000001301","volume":"62","author":"H Mao","year":"2019","unstructured":"Mao H, Milne TGE, O\u2019Grady G, Vather R, Edlin R, Bissett I (2019) Prolonged postoperative ileus significantly increases the cost of inpatient stay for patients undergoing elective colorectal surgery: Results of a multivariate analysis of prospective data at a single institution. Dis Colon Rectum 62(5):631\u2013637. https:\/\/doi.org\/10.1097\/DCR.0000000000001301","journal-title":"Dis Colon Rectum"},{"key":"5152_CR15","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1111\/codi.16235","volume":"24","author":"L Traeger","year":"2022","unstructured":"Traeger L, Koullouros M, Bedrikovetski S, Kroon HM, Thomas ML, Moore JW et al (2022) Cost of postoperative ileus following colorectal surgery: a cost analysis in the Australian public hospital setting. Colorectal Dis 24:1416\u20131426","journal-title":"Colorectal Dis"},{"key":"5152_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2025.109397","volume":"184","author":"UO Gustafsson","year":"2025","unstructured":"Gustafsson UO, Rockall TA, Wexner S, How KY, Emile S, Marchuk A et al (2025) Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025. Surgery 184:109397. https:\/\/doi.org\/10.1016\/j.surg.2025.109397","journal-title":"Surgery"},{"issue":"2","key":"5152_CR17","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.jviscsurg.2016.08.003","volume":"154","author":"J Barbieux","year":"2017","unstructured":"Barbieux J, Hamy A, Talbot MF, Casa C, Mucci S, Lermite E et al (2017) Does enhanced recovery reduce postoperative ileus after colorectal surgery? J Visc Surg 154(2):79\u201385. https:\/\/doi.org\/10.1016\/j.jviscsurg.2016.08.003","journal-title":"J Visc Surg"},{"issue":"2","key":"5152_CR18","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1159\/000537805","volume":"41","author":"EK Abernethy","year":"2024","unstructured":"Abernethy EK, Aly EH (2024) Postoperative ileus after minimally invasive colorectal surgery: a summary of current strategies for prevention and management. Dig Surg 41(2):79\u201391. https:\/\/doi.org\/10.1159\/000537805","journal-title":"Dig Surg"},{"issue":"2","key":"5152_CR19","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1007\/s12262-021-02899-8","volume":"84","author":"P Koci\u00e1n","year":"2022","unstructured":"Koci\u00e1n P, Whitley A (2022) Prolonged postoperative ileus in colorectal surgery within an enhanced recovery protocol: a multivariate analysis. Indian J Surg 84(2):340\u2013344","journal-title":"Indian J Surg"},{"issue":"8","key":"5152_CR20","doi-asserted-by":"publisher","first-page":"4796","DOI":"10.1097\/JS9.0000000000001601","volume":"110","author":"A Pesce","year":"2024","unstructured":"Pesce A, Ram\u00edrez JM, Fabbri N, Mart\u00ednez Ubieto J, Pascual Bellosta A, Arroyo A, S\u00e1nchez-Guill\u00e9n L, Whitley A, Koci\u00e1n P, Rosetzka K, Bona Enguita A, Ioannidis O, Bitsianis S, Symeonidis S, Anestiadou E, Teresa-Fernand\u00e9z M, Feo CV (2024) The EUropeanPErioperativeMEdical Networking (EUPEMEN) project and recommendations for perioperative care in colorectal surgery: a quality improvement study. Int J Surg 110(8):4796\u20134803. https:\/\/doi.org\/10.1097\/JS9.0000000000001601","journal-title":"Int J Surg"},{"issue":"5","key":"5152_CR21","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1080\/13645706.2024.2360094","volume":"33","author":"CA Ammirati","year":"2024","unstructured":"Ammirati CA, Passera R, Beltrami E, Peluso C, Francis N, Arezzo A (2024) Laparoscopic and robotic surgery for colorectal cancer in older patients: a systematic review and meta-analysis. Minim Invasive Ther Allied Technol 33(5):253\u2013269. https:\/\/doi.org\/10.1080\/13645706.2024.2360094","journal-title":"Minim Invasive Ther Allied Technol"},{"issue":"4","key":"5152_CR22","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1016\/j.surg.2014.12.005","volume":"157","author":"R Vather","year":"2015","unstructured":"Vather R, Josephson R, Jaung R, Robertson J, Bissett I (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157(4):764\u201373. https:\/\/doi.org\/10.1016\/j.surg.2014.12.005","journal-title":"Surgery"},{"key":"5152_CR23","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1093\/ckj\/sfaa188","volume":"14","author":"CL Ramspek","year":"2021","unstructured":"Ramspek CL, Jager KJ, Dekker FW, Zoccali C, van Diepen M (2021) External validation of prognostic models: what, why, how, when and where? Clin Kidney J 14:49\u201358","journal-title":"Clin Kidney J"}],"container-title":["International Journal of Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00384-026-05152-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-026-05152-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-026-05152-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:28:25Z","timestamp":1784089705000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00384-026-05152-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5152"],"URL":"https:\/\/doi.org\/10.1007\/s00384-026-05152-4","relation":{},"ISSN":["1432-1262"],"issn-type":[{"value":"1432-1262","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"assertion":[{"value":"18 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All patients included in the study signed a written informed consent before surgery.","order":1,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"120"}}